| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,008 |
2,775 |
$78K |
| D0210 |
Intraoral - complete series of radiographic images |
785 |
704 |
$34K |
| D1999 |
|
1,998 |
1,911 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
2,307 |
2,143 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
751 |
673 |
$15K |
| D0272 |
Bitewings - two radiographic images |
897 |
847 |
$13K |
| D2140 |
|
333 |
173 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,339 |
1,126 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
236 |
155 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
883 |
833 |
$6K |
| D2330 |
|
23 |
12 |
$512.00 |