| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,329 |
1,325 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
1,831 |
1,828 |
$46K |
| D1120 |
Prophylaxis - child |
676 |
675 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,827 |
1,721 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
987 |
986 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
605 |
582 |
$22K |
| D0274 |
Bitewings - four radiographic images |
662 |
662 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,480 |
1,349 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
82 |
82 |
$3K |
| D0272 |
Bitewings - two radiographic images |
113 |
113 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
14 |
12 |
$952.63 |