| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
668 |
659 |
$23K |
| D0274 |
Bitewings - four radiographic images |
816 |
802 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
911 |
899 |
$15K |
| D1120 |
Prophylaxis - child |
530 |
519 |
$11K |
| D1206 |
Topical application of fluoride varnish |
469 |
465 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
477 |
471 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
261 |
258 |
$7K |
| D2140 |
|
100 |
64 |
$4K |
| D0272 |
Bitewings - two radiographic images |
177 |
177 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
16 |
14 |
$907.20 |
| D0220 |
Intraoral - periapical first radiographic image |
65 |
63 |
$306.75 |