| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9945 |
|
1,751 |
1,749 |
$254K |
| D1110 |
Prophylaxis - adult |
3,398 |
3,398 |
$187K |
| D0274 |
Bitewings - four radiographic images |
3,372 |
3,372 |
$93K |
| D0120 |
Periodic oral evaluation - established patient |
2,394 |
2,394 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,266 |
1,266 |
$38K |
| D1120 |
Prophylaxis - child |
807 |
807 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
1,151 |
1,145 |
$31K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
259 |
167 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,624 |
1,624 |
$23K |
| D1351 |
Sealant - per tooth |
286 |
161 |
$21K |
| D2160 |
|
80 |
58 |
$10K |
| D0272 |
Bitewings - two radiographic images |
600 |
600 |
$10K |
| D0330 |
Panoramic radiographic image |
272 |
272 |
$10K |
| D2140 |
|
94 |
76 |
$6K |
| D2332 |
|
32 |
26 |
$5K |
| D9940 |
|
15 |
15 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
74 |
74 |
$973.84 |
| D0140 |
Limited oral evaluation - problem focused |
39 |
39 |
$546.00 |