| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,750 |
3,750 |
$126K |
| D0120 |
Periodic oral evaluation - established patient |
2,976 |
2,975 |
$58K |
| D0274 |
Bitewings - four radiographic images |
2,473 |
2,473 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
1,907 |
1,893 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
3,797 |
3,781 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,633 |
1,633 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,469 |
3,465 |
$30K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
233 |
139 |
$12K |
| D2750 |
|
45 |
24 |
$12K |
| D1120 |
Prophylaxis - child |
309 |
308 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
762 |
761 |
$9K |
| D0272 |
Bitewings - two radiographic images |
126 |
126 |
$1K |