| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,362 |
1,278 |
$59K |
| D0210 |
Intraoral - complete series of radiographic images |
631 |
595 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
1,590 |
1,525 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,388 |
1,311 |
$25K |
| D0272 |
Bitewings - two radiographic images |
852 |
813 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
765 |
735 |
$12K |
| D1206 |
Topical application of fluoride varnish |
497 |
460 |
$8K |
| D1120 |
Prophylaxis - child |
194 |
192 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
63 |
37 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
305 |
247 |
$4K |
| D0274 |
Bitewings - four radiographic images |
159 |
152 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
57 |
53 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
41 |
41 |
$1K |
| D0330 |
Panoramic radiographic image |
35 |
33 |
$940.50 |