| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
831 |
692 |
$20K |
| D1999 |
|
530 |
453 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
602 |
476 |
$6K |
| D0272 |
Bitewings - two radiographic images |
386 |
298 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
139 |
75 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
185 |
152 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
184 |
142 |
$2K |
| D2140 |
|
74 |
37 |
$2K |
| D1120 |
Prophylaxis - child |
75 |
57 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
201 |
161 |
$966.84 |
| D0230 |
Intraoral - periapical each additional radiographic image |
78 |
40 |
$269.80 |