| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,668 |
1,444 |
$41K |
| D1999 |
|
2,596 |
2,129 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,345 |
1,165 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
849 |
765 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
670 |
596 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,892 |
910 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
624 |
559 |
$9K |
| D1120 |
Prophylaxis - child |
288 |
265 |
$5K |
| D0272 |
Bitewings - two radiographic images |
211 |
181 |
$3K |
| D2161 |
|
21 |
12 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
49 |
25 |
$1K |