| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,422 |
3,347 |
$91K |
| D1999 |
|
3,456 |
3,347 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,651 |
2,527 |
$40K |
| D0272 |
Bitewings - two radiographic images |
2,372 |
2,305 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
2,449 |
2,384 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,178 |
1,147 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,553 |
1,507 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
497 |
484 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
109 |
77 |
$4K |
| D1120 |
Prophylaxis - child |
31 |
31 |
$494.00 |