| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
3,050 |
1,937 |
$44K |
| D1110 |
Prophylaxis - adult |
1,274 |
746 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,075 |
633 |
$25K |
| D0272 |
Bitewings - two radiographic images |
843 |
474 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
828 |
473 |
$12K |
| D1120 |
Prophylaxis - child |
575 |
330 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
750 |
438 |
$12K |
| D2140 |
|
248 |
161 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,023 |
563 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
152 |
117 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
114 |
60 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
31 |
14 |
$295.12 |