| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,760 |
2,594 |
$75K |
| D1999 |
|
2,693 |
2,563 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
2,343 |
2,223 |
$34K |
| D2140 |
|
950 |
555 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,068 |
1,027 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,663 |
1,414 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
259 |
258 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
490 |
459 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
281 |
213 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,059 |
1,019 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
401 |
373 |
$6K |
| D1120 |
Prophylaxis - child |
36 |
36 |
$718.40 |