| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
416 |
307 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
285 |
210 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
239 |
178 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
297 |
219 |
$3K |
| D0272 |
Bitewings - two radiographic images |
186 |
137 |
$2K |
| D1120 |
Prophylaxis - child |
143 |
115 |
$2K |
| D2940 |
|
103 |
68 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
123 |
82 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
154 |
111 |
$803.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
28 |
12 |
$678.40 |