| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
2,449 |
1,876 |
$35K |
| D1110 |
Prophylaxis - adult |
1,123 |
951 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,216 |
735 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
605 |
542 |
$14K |
| D0272 |
Bitewings - two radiographic images |
680 |
601 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
624 |
504 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
875 |
754 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
298 |
264 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
51 |
36 |
$2K |
| D1120 |
Prophylaxis - child |
41 |
40 |
$820.00 |
| D0140 |
Limited oral evaluation - problem focused |
26 |
15 |
$472.86 |