| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,958 |
1,850 |
$50K |
| D1999 |
|
2,597 |
2,384 |
$35K |
| D2140 |
|
737 |
321 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
1,403 |
1,321 |
$19K |
| D0272 |
Bitewings - two radiographic images |
991 |
932 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
652 |
615 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
278 |
152 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
451 |
430 |
$6K |
| D0330 |
Panoramic radiographic image |
99 |
99 |
$3K |
| D1120 |
Prophylaxis - child |
115 |
110 |
$2K |
| D2330 |
|
41 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
133 |
119 |
$931.00 |
| D1351 |
Sealant - per tooth |
67 |
12 |
$882.20 |