| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
8,439 |
6,950 |
$243K |
| D1999 |
|
8,406 |
6,945 |
$123K |
| D0330 |
Panoramic radiographic image |
3,904 |
3,239 |
$118K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,353 |
3,627 |
$94K |
| D0272 |
Bitewings - two radiographic images |
6,294 |
5,167 |
$92K |
| D0120 |
Periodic oral evaluation - established patient |
5,989 |
4,863 |
$85K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,636 |
2,912 |
$51K |
| D1120 |
Prophylaxis - child |
1,535 |
1,181 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
159 |
126 |
$5K |
| D1351 |
Sealant - per tooth |
309 |
32 |
$5K |
| D2140 |
|
67 |
40 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
55 |
36 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
58 |
57 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
107 |
100 |
$624.05 |
| D0220 |
Intraoral - periapical first radiographic image |
69 |
59 |
$446.24 |