| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,594 |
2,553 |
$73K |
| D1110 |
Prophylaxis - adult |
1,240 |
1,223 |
$66K |
| D1120 |
Prophylaxis - child |
1,549 |
1,524 |
$55K |
| D0272 |
Bitewings - two radiographic images |
2,028 |
2,006 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,752 |
2,713 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,204 |
2,348 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,513 |
2,460 |
$31K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
69 |
42 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
12 |
$429.52 |
| D0603 |
|
1,792 |
1,766 |
$0.00 |
| D0602 |
|
682 |
668 |
$0.00 |
| D0601 |
|
28 |
28 |
$0.00 |
| D1999 |
|
1,678 |
1,588 |
$0.00 |