| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,441 |
2,250 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,091 |
2,333 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,278 |
2,038 |
$40K |
| D1351 |
Sealant - per tooth |
2,937 |
424 |
$39K |
| D1999 |
|
1,893 |
1,634 |
$31K |
| D0272 |
Bitewings - two radiographic images |
2,275 |
2,071 |
$30K |
| D2140 |
|
680 |
380 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,386 |
1,259 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
2,468 |
2,253 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
1,201 |
1,157 |
$17K |
| D1120 |
Prophylaxis - child |
951 |
862 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
259 |
164 |
$8K |
| D2330 |
|
244 |
90 |
$6K |
| D2331 |
|
62 |
27 |
$2K |
| D2160 |
|
44 |
30 |
$1K |
| D2940 |
|
21 |
18 |
$357.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$207.80 |