| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,442 |
3,442 |
$121K |
| D1110 |
Prophylaxis - adult |
2,530 |
2,530 |
$116K |
| D0120 |
Periodic oral evaluation - established patient |
4,082 |
4,082 |
$81K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,099 |
874 |
$80K |
| D0274 |
Bitewings - four radiographic images |
2,205 |
2,205 |
$63K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,249 |
3,249 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,242 |
1,242 |
$35K |
| D1351 |
Sealant - per tooth |
1,092 |
334 |
$28K |
| D1206 |
Topical application of fluoride varnish |
1,354 |
1,354 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
959 |
956 |
$22K |
| D2140 |
|
393 |
318 |
$17K |
| D0272 |
Bitewings - two radiographic images |
646 |
646 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,143 |
1,134 |
$12K |
| D0330 |
Panoramic radiographic image |
237 |
237 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
95 |
95 |
$5K |
| D2160 |
|
15 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
87 |
87 |
$188.30 |
| D1999 |
|
56 |
54 |
$0.00 |