| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,296 |
2,776 |
$110K |
| D0210 |
Intraoral - complete series of radiographic images |
1,812 |
1,594 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,446 |
2,142 |
$49K |
| D5110 |
|
80 |
65 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
3,425 |
2,887 |
$20K |
| D1120 |
Prophylaxis - child |
1,198 |
1,012 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
1,662 |
1,373 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,493 |
3,786 |
$5K |
| D1351 |
Sealant - per tooth |
1,566 |
199 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
92 |
49 |
$3K |
| D0274 |
Bitewings - four radiographic images |
1,195 |
993 |
$1K |
| D0272 |
Bitewings - two radiographic images |
629 |
513 |
$835.58 |
| D2140 |
|
16 |
13 |
$680.00 |
| D0220 |
Intraoral - periapical first radiographic image |
975 |
827 |
$630.18 |
| D0230 |
Intraoral - periapical each additional radiographic image |
13 |
13 |
$62.88 |