| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
875 |
853 |
$26K |
| D1999 |
|
666 |
627 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
479 |
475 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
230 |
229 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
288 |
279 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
120 |
120 |
$2K |
| D2140 |
|
53 |
28 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
87 |
80 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
24 |
24 |
$989.51 |
| D0272 |
Bitewings - two radiographic images |
39 |
39 |
$567.63 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
16 |
13 |
$435.55 |