| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
978 |
974 |
$81K |
| D9430 |
|
2,247 |
2,212 |
$71K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
777 |
777 |
$50K |
| D1120 |
Prophylaxis - child |
1,294 |
1,291 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
937 |
931 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,717 |
1,419 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
479 |
479 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,064 |
1,061 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
106 |
53 |
$7K |
| D0272 |
Bitewings - two radiographic images |
436 |
436 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
415 |
414 |
$5K |
| D2330 |
|
20 |
12 |
$2K |