| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,694 |
1,577 |
$43K |
| D1999 |
|
2,178 |
1,893 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,217 |
1,127 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
491 |
303 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
803 |
742 |
$15K |
| D2140 |
|
549 |
306 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
935 |
855 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,625 |
1,512 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,957 |
1,379 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
395 |
361 |
$5K |
| D1120 |
Prophylaxis - child |
63 |
59 |
$984.35 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$207.02 |