| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,136 |
2,655 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,152 |
1,739 |
$36K |
| D0272 |
Bitewings - two radiographic images |
2,387 |
1,998 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,743 |
1,539 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,071 |
862 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
2,449 |
2,117 |
$14K |
| D1999 |
|
890 |
703 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,075 |
1,616 |
$11K |
| D2140 |
|
299 |
248 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
495 |
453 |
$7K |
| D1120 |
Prophylaxis - child |
397 |
306 |
$7K |
| D2330 |
|
170 |
114 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
89 |
82 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
95 |
69 |
$2K |
| D2940 |
|
82 |
73 |
$1K |