| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,772 |
2,355 |
$76K |
| D1999 |
|
2,945 |
2,546 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,546 |
1,272 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,968 |
1,677 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
2,024 |
1,759 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,077 |
910 |
$15K |
| D1120 |
Prophylaxis - child |
321 |
257 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
337 |
282 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
50 |
42 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19 |
14 |
$68.40 |