| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,688 |
4,978 |
$154K |
| D1999 |
|
7,324 |
6,288 |
$105K |
| D2140 |
|
2,369 |
1,342 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
5,077 |
4,454 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,280 |
1,989 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,959 |
2,600 |
$42K |
| D1120 |
Prophylaxis - child |
1,651 |
1,442 |
$30K |
| D2940 |
|
938 |
856 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,168 |
985 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
2,106 |
1,936 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
907 |
828 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,924 |
1,532 |
$15K |
| D0330 |
Panoramic radiographic image |
425 |
287 |
$14K |
| D2330 |
|
121 |
75 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
63 |
53 |
$2K |