| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,650 |
3,638 |
$137K |
| D0120 |
Periodic oral evaluation - established patient |
5,047 |
5,032 |
$101K |
| D0274 |
Bitewings - four radiographic images |
3,476 |
3,470 |
$69K |
| D1120 |
Prophylaxis - child |
2,145 |
2,142 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
1,339 |
1,333 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,074 |
3,066 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,011 |
1,009 |
$21K |
| D1351 |
Sealant - per tooth |
316 |
154 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,022 |
1,019 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
677 |
644 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
17 |
12 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
13 |
$816.56 |
| D0140 |
Limited oral evaluation - problem focused |
58 |
58 |
$615.42 |
| D1999 |
|
63 |
63 |
$0.00 |