| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,301 |
1,979 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
2,113 |
1,815 |
$26K |
| D1999 |
|
1,135 |
1,009 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
296 |
246 |
$11K |
| D0272 |
Bitewings - two radiographic images |
623 |
512 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
544 |
451 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
340 |
274 |
$5K |
| D2140 |
|
147 |
103 |
$3K |
| D1120 |
Prophylaxis - child |
172 |
144 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
119 |
67 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
35 |
26 |
$140.80 |