| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,553 |
4,522 |
$198K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,353 |
7,288 |
$156K |
| D0120 |
Periodic oral evaluation - established patient |
6,038 |
5,986 |
$147K |
| D1120 |
Prophylaxis - child |
2,757 |
2,729 |
$93K |
| D0274 |
Bitewings - four radiographic images |
3,577 |
3,553 |
$93K |
| D0330 |
Panoramic radiographic image |
1,204 |
1,190 |
$52K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
671 |
499 |
$49K |
| D2140 |
|
734 |
602 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
3,271 |
3,232 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,091 |
1,085 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,530 |
2,501 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
147 |
146 |
$9K |
| D0272 |
Bitewings - two radiographic images |
271 |
269 |
$5K |
| D1351 |
Sealant - per tooth |
147 |
45 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
106 |
106 |
$3K |
| D2160 |
|
19 |
13 |
$2K |