| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,226 |
1,203 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
1,761 |
1,714 |
$103K |
| D1120 |
Prophylaxis - child |
1,287 |
1,273 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
814 |
779 |
$52K |
| D0274 |
Bitewings - four radiographic images |
2,274 |
2,257 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,606 |
3,237 |
$39K |
| D9110 |
|
665 |
567 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,823 |
2,793 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
1,906 |
1,646 |
$23K |
| D9430 |
|
74 |
64 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
19 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$312.00 |
| D9951 |
|
12 |
12 |
$280.00 |