| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
437 |
390 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
480 |
428 |
$7K |
| D0272 |
Bitewings - two radiographic images |
390 |
349 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
149 |
135 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
195 |
164 |
$1K |
| D1120 |
Prophylaxis - child |
49 |
43 |
$761.40 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
28 |
12 |
$693.60 |
| D2160 |
|
16 |
12 |
$489.60 |
| D0120 |
Periodic oral evaluation - established patient |
45 |
44 |
$425.70 |
| D0230 |
Intraoral - periapical each additional radiographic image |
21 |
12 |
$75.60 |