| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,493 |
2,401 |
$65K |
| D1999 |
|
2,821 |
2,598 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,935 |
1,858 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
1,706 |
1,651 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
861 |
824 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,085 |
1,528 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,703 |
1,636 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
237 |
216 |
$3K |
| D1120 |
Prophylaxis - child |
77 |
64 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
15 |
12 |
$731.70 |
| D2140 |
|
19 |
13 |
$649.06 |
| D0140 |
Limited oral evaluation - problem focused |
17 |
15 |
$199.10 |