| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
364 |
346 |
$24K |
| D1206 |
Topical application of fluoride varnish |
547 |
514 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
491 |
463 |
$20K |
| D0274 |
Bitewings - four radiographic images |
301 |
291 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
536 |
506 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
431 |
243 |
$11K |
| D1120 |
Prophylaxis - child |
182 |
165 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
42 |
34 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
19 |
12 |
$3K |
| D2140 |
|
15 |
13 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
32 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
18 |
14 |
$743.00 |