| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,341 |
1,137 |
$33K |
| D1999 |
|
1,346 |
1,206 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
1,293 |
1,087 |
$15K |
| D0272 |
Bitewings - two radiographic images |
817 |
692 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,436 |
922 |
$8K |
| D2140 |
|
297 |
126 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
938 |
806 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
179 |
108 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
295 |
227 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
236 |
190 |
$3K |
| D1120 |
Prophylaxis - child |
29 |
29 |
$453.60 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$248.21 |