| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,857 |
1,795 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
2,281 |
2,209 |
$43K |
| D0274 |
Bitewings - four radiographic images |
688 |
672 |
$17K |
| D1206 |
Topical application of fluoride varnish |
951 |
907 |
$15K |
| D1120 |
Prophylaxis - child |
243 |
232 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
62 |
60 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
22 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
96 |
89 |
$936.25 |
| D0210 |
Intraoral - complete series of radiographic images |
17 |
17 |
$749.66 |