| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,871 |
1,800 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
2,693 |
2,579 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,056 |
1,001 |
$16K |
| D1120 |
Prophylaxis - child |
611 |
567 |
$12K |
| D0274 |
Bitewings - four radiographic images |
312 |
304 |
$7K |
| D0272 |
Bitewings - two radiographic images |
361 |
330 |
$4K |
| D1206 |
Topical application of fluoride varnish |
158 |
148 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
45 |
28 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
38 |
37 |
$2K |
| D2140 |
|
40 |
30 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
26 |
26 |
$716.42 |
| D0220 |
Intraoral - periapical first radiographic image |
15 |
12 |
$75.75 |