| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
10,691 |
8,949 |
$304K |
| D1999 |
|
12,442 |
9,795 |
$181K |
| D0120 |
Periodic oral evaluation - established patient |
7,852 |
6,487 |
$118K |
| D0330 |
Panoramic radiographic image |
3,033 |
2,482 |
$93K |
| D0272 |
Bitewings - two radiographic images |
6,260 |
5,260 |
$93K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,161 |
812 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,194 |
1,984 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,236 |
1,946 |
$32K |
| D2140 |
|
449 |
334 |
$17K |
| D2160 |
|
182 |
155 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
404 |
278 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
215 |
207 |
$2K |
| D2330 |
|
22 |
12 |
$954.68 |
| D2940 |
|
21 |
18 |
$654.75 |
| D0140 |
Limited oral evaluation - problem focused |
30 |
30 |
$600.62 |