| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9430 |
|
1,522 |
1,316 |
$48K |
| D1110 |
Prophylaxis - adult |
456 |
444 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
543 |
539 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,943 |
1,387 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
126 |
121 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
396 |
391 |
$6K |
| D1120 |
Prophylaxis - child |
180 |
179 |
$6K |
| D0272 |
Bitewings - two radiographic images |
419 |
412 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
56 |
56 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
23 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
109 |
99 |
$1K |