| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,309 |
1,066 |
$33K |
| D1999 |
|
944 |
801 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
889 |
680 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
359 |
289 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
312 |
223 |
$4K |
| D0272 |
Bitewings - two radiographic images |
284 |
205 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
335 |
272 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
644 |
154 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
105 |
51 |
$3K |
| D1120 |
Prophylaxis - child |
89 |
60 |
$1K |
| D2140 |
|
68 |
27 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
175 |
126 |
$929.01 |