| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,000 |
2,503 |
$80K |
| D1999 |
|
3,723 |
3,203 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
2,910 |
2,429 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,755 |
1,470 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,239 |
1,855 |
$31K |
| D1120 |
Prophylaxis - child |
1,637 |
1,354 |
$31K |
| D2140 |
|
1,040 |
487 |
$28K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
638 |
364 |
$21K |
| D0272 |
Bitewings - two radiographic images |
711 |
640 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
643 |
541 |
$4K |
| D2161 |
|
49 |
42 |
$3K |
| D1351 |
Sealant - per tooth |
154 |
13 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
227 |
116 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
73 |
73 |
$1K |
| D2940 |
|
48 |
40 |
$857.00 |
| D2160 |
|
14 |
12 |
$798.90 |