| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,677 |
1,502 |
$47K |
| D1999 |
|
1,254 |
1,148 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
1,380 |
1,254 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,015 |
858 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
387 |
310 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
416 |
342 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
889 |
696 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
808 |
647 |
$6K |
| D1120 |
Prophylaxis - child |
230 |
160 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
18 |
14 |
$462.72 |