| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,827 |
1,545 |
$48K |
| D0272 |
Bitewings - two radiographic images |
1,269 |
1,076 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
1,412 |
1,213 |
$18K |
| D1999 |
|
788 |
718 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
272 |
231 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
239 |
183 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
71 |
42 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
190 |
137 |
$1K |
| D2140 |
|
42 |
25 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
36 |
27 |
$622.51 |