| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,384 |
2,563 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
3,179 |
2,387 |
$40K |
| D0272 |
Bitewings - two radiographic images |
2,385 |
1,749 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,301 |
2,292 |
$22K |
| D1999 |
|
1,296 |
1,110 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
2,611 |
1,911 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,080 |
723 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
468 |
327 |
$8K |
| D1120 |
Prophylaxis - child |
412 |
242 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
74 |
42 |
$3K |
| D2140 |
|
55 |
25 |
$948.72 |
| D0140 |
Limited oral evaluation - problem focused |
23 |
12 |
$400.83 |