| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
859 |
800 |
$22K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
627 |
299 |
$22K |
| D2140 |
|
763 |
309 |
$21K |
| D7250 |
|
393 |
207 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
885 |
829 |
$16K |
| D0272 |
Bitewings - two radiographic images |
573 |
536 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
732 |
683 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
607 |
546 |
$4K |
| D1999 |
|
217 |
152 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
177 |
170 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
174 |
163 |
$2K |
| D1120 |
Prophylaxis - child |
93 |
86 |
$1K |
| D2160 |
|
16 |
13 |
$488.60 |