| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,139 |
3,133 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
2,508 |
2,501 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,418 |
1,418 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,449 |
1,445 |
$16K |
| D0274 |
Bitewings - four radiographic images |
1,287 |
1,285 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
701 |
673 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
295 |
295 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
939 |
909 |
$3K |
| D1120 |
Prophylaxis - child |
132 |
132 |
$3K |
| D0272 |
Bitewings - two radiographic images |
303 |
303 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
24 |
13 |
$850.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
13 |
12 |
$30.00 |