| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,909 |
2,472 |
$76K |
| D1999 |
|
3,528 |
3,223 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,057 |
1,787 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,058 |
1,742 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
2,186 |
1,859 |
$28K |
| D1120 |
Prophylaxis - child |
1,335 |
1,134 |
$24K |
| D0272 |
Bitewings - two radiographic images |
818 |
763 |
$12K |
| D2140 |
|
343 |
180 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
800 |
778 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
742 |
635 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
135 |
99 |
$5K |
| D1351 |
Sealant - per tooth |
260 |
40 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
62 |
62 |
$1K |