| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,997 |
2,564 |
$85K |
| D1999 |
|
2,972 |
2,319 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
2,092 |
1,822 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
477 |
379 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
973 |
802 |
$17K |
| D0272 |
Bitewings - two radiographic images |
963 |
838 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
283 |
142 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
831 |
490 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
425 |
372 |
$6K |
| D2140 |
|
140 |
70 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
465 |
394 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
69 |
26 |
$3K |
| D1120 |
Prophylaxis - child |
134 |
119 |
$2K |
| D2160 |
|
47 |
31 |
$2K |