| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,735 |
5,583 |
$160K |
| D1999 |
|
9,660 |
9,093 |
$136K |
| D0120 |
Periodic oral evaluation - established patient |
5,633 |
5,482 |
$84K |
| D0272 |
Bitewings - two radiographic images |
4,815 |
4,683 |
$71K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,747 |
5,437 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,750 |
1,707 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
4,943 |
4,805 |
$41K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
865 |
554 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,486 |
2,420 |
$36K |
| D1120 |
Prophylaxis - child |
1,416 |
1,380 |
$27K |
| D1351 |
Sealant - per tooth |
1,578 |
194 |
$25K |
| D2335 |
|
90 |
54 |
$7K |
| D2140 |
|
177 |
124 |
$7K |
| D2160 |
|
90 |
79 |
$5K |
| D2940 |
|
23 |
14 |
$687.50 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
13 |
$249.12 |