| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,537 |
1,212 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
655 |
530 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
1,294 |
1,010 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
711 |
559 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
736 |
554 |
$10K |
| D0272 |
Bitewings - two radiographic images |
642 |
507 |
$9K |
| D1120 |
Prophylaxis - child |
359 |
272 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
78 |
64 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
379 |
204 |
$2K |
| D2140 |
|
69 |
53 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$59.40 |