| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,339 |
2,279 |
$62K |
| D1999 |
|
2,327 |
2,239 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,489 |
1,529 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
1,694 |
1,646 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,526 |
1,494 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
663 |
651 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
509 |
501 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
855 |
834 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
82 |
66 |
$3K |
| D1120 |
Prophylaxis - child |
51 |
51 |
$790.00 |
| D2140 |
|
37 |
26 |
$626.40 |