| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,975 |
3,113 |
$107K |
| D1999 |
|
3,386 |
2,747 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
3,531 |
2,828 |
$47K |
| D0272 |
Bitewings - two radiographic images |
1,324 |
1,002 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,377 |
1,045 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
863 |
585 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,021 |
768 |
$7K |
| D1120 |
Prophylaxis - child |
389 |
273 |
$7K |
| D2140 |
|
80 |
51 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
30 |
25 |
$1K |
| D9996 |
|
63 |
57 |
$810.50 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
13 |
$225.54 |