| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,607 |
5,353 |
$283K |
| D0120 |
Periodic oral evaluation - established patient |
5,105 |
4,893 |
$109K |
| D0210 |
Intraoral - complete series of radiographic images |
459 |
453 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
768 |
746 |
$30K |
| D0274 |
Bitewings - four radiographic images |
893 |
806 |
$29K |
| D0272 |
Bitewings - two radiographic images |
878 |
863 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,413 |
1,322 |
$20K |
| D9110 |
|
446 |
405 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
397 |
394 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
166 |
161 |
$6K |
| D1120 |
Prophylaxis - child |
105 |
102 |
$5K |
| D2160 |
|
19 |
15 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
13 |
12 |
$881.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
36 |
25 |
$390.00 |