| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,230 |
3,101 |
$132K |
| D0120 |
Periodic oral evaluation - established patient |
3,276 |
3,148 |
$91K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,227 |
854 |
$90K |
| D1351 |
Sealant - per tooth |
1,207 |
686 |
$85K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,054 |
2,934 |
$79K |
| D0274 |
Bitewings - four radiographic images |
1,365 |
1,323 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,664 |
2,569 |
$15K |
| D2160 |
|
119 |
91 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,406 |
2,325 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
381 |
364 |
$8K |
| D2140 |
|
152 |
118 |
$6K |
| D0330 |
Panoramic radiographic image |
174 |
159 |
$4K |
| D0272 |
Bitewings - two radiographic images |
378 |
356 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
98 |
93 |
$2K |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$492.00 |
| D1999 |
|
199 |
155 |
$0.00 |