| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,281 |
7,278 |
$302K |
| D0120 |
Periodic oral evaluation - established patient |
6,721 |
6,717 |
$146K |
| D0274 |
Bitewings - four radiographic images |
6,075 |
6,075 |
$132K |
| D0220 |
Intraoral - periapical first radiographic image |
7,527 |
7,464 |
$79K |
| D0210 |
Intraoral - complete series of radiographic images |
1,827 |
1,818 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,011 |
5,938 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
781 |
781 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
1,415 |
1,401 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,052 |
1,051 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
85 |
69 |
$5K |
| D2750 |
|
12 |
12 |
$4K |
| D2954 |
|
42 |
40 |
$4K |
| D2161 |
|
40 |
36 |
$4K |
| D2160 |
|
49 |
40 |
$3K |
| D1120 |
Prophylaxis - child |
49 |
49 |
$2K |
| D2335 |
|
15 |
12 |
$2K |