| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
785 |
689 |
$11K |
| D1110 |
Prophylaxis - adult |
312 |
252 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
218 |
177 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
98 |
68 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
227 |
65 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
25 |
14 |
$857.42 |
| D0220 |
Intraoral - periapical first radiographic image |
151 |
128 |
$732.15 |
| D0272 |
Bitewings - two radiographic images |
38 |
37 |
$520.69 |
| D0140 |
Limited oral evaluation - problem focused |
45 |
45 |
$427.89 |
| D1120 |
Prophylaxis - child |
20 |
16 |
$333.60 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$170.76 |