| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,303 |
2,763 |
$90K |
| D1999 |
|
3,398 |
3,002 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
2,979 |
2,495 |
$41K |
| D0272 |
Bitewings - two radiographic images |
2,161 |
1,811 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
958 |
793 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
674 |
582 |
$12K |
| D1120 |
Prophylaxis - child |
260 |
197 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
233 |
172 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
37 |
24 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
161 |
122 |
$988.91 |
| D2140 |
|
43 |
27 |
$924.32 |
| D2160 |
|
12 |
12 |
$355.20 |
| D2940 |
|
19 |
14 |
$302.50 |