| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
440 |
425 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
394 |
312 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
192 |
115 |
$5K |
| D0272 |
Bitewings - two radiographic images |
306 |
300 |
$4K |
| D2140 |
|
161 |
100 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
313 |
303 |
$3K |
| D2160 |
|
90 |
60 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
182 |
174 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
318 |
310 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
85 |
83 |
$1K |