| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,065 |
1,688 |
$60K |
| D1999 |
|
2,390 |
1,852 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,105 |
1,141 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
1,492 |
1,182 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,042 |
845 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,186 |
978 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
246 |
218 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
137 |
122 |
$2K |
| D2140 |
|
50 |
24 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
19 |
14 |
$433.29 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$217.80 |