| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,151 |
1,049 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
810 |
714 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,539 |
684 |
$13K |
| D1999 |
|
741 |
713 |
$11K |
| D0272 |
Bitewings - two radiographic images |
750 |
664 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
756 |
698 |
$9K |
| D2140 |
|
208 |
119 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
509 |
458 |
$6K |
| D1120 |
Prophylaxis - child |
365 |
328 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
863 |
764 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
158 |
91 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
15 |
13 |
$140.40 |