| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,166 |
990 |
$28K |
| D1999 |
|
1,501 |
1,166 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
897 |
761 |
$15K |
| D2140 |
|
328 |
152 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
154 |
137 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
410 |
348 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
451 |
371 |
$5K |
| D1120 |
Prophylaxis - child |
220 |
181 |
$4K |
| D0272 |
Bitewings - two radiographic images |
285 |
240 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
407 |
341 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
505 |
301 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
17 |
13 |
$425.90 |