| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
2,698 |
2,374 |
$36K |
| D1110 |
Prophylaxis - adult |
1,600 |
1,314 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,538 |
1,255 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
917 |
759 |
$12K |
| D0272 |
Bitewings - two radiographic images |
735 |
611 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
639 |
530 |
$9K |
| D1120 |
Prophylaxis - child |
567 |
456 |
$9K |
| D2140 |
|
393 |
223 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
682 |
587 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,125 |
937 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
204 |
122 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
909 |
688 |
$3K |
| D1351 |
Sealant - per tooth |
247 |
48 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
123 |
79 |
$3K |
| D0330 |
Panoramic radiographic image |
27 |
27 |
$809.97 |
| D8670 |
Periodic orthodontic treatment visit |
1,196 |
1,120 |
$0.00 |