| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,658 |
3,502 |
$125K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,583 |
1,935 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
4,739 |
3,553 |
$61K |
| D1999 |
|
4,035 |
3,157 |
$60K |
| D0272 |
Bitewings - two radiographic images |
3,070 |
2,329 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,690 |
1,219 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,564 |
1,950 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
185 |
111 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
431 |
286 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
214 |
155 |
$7K |
| D1120 |
Prophylaxis - child |
351 |
224 |
$6K |
| D2140 |
|
148 |
99 |
$4K |
| D2160 |
|
14 |
13 |
$477.26 |
| D0140 |
Limited oral evaluation - problem focused |
24 |
17 |
$433.41 |