| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,809 |
1,530 |
$51K |
| D1999 |
|
1,654 |
1,327 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
1,225 |
1,043 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
393 |
361 |
$7K |
| D2140 |
|
121 |
41 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
187 |
112 |
$3K |
| D0272 |
Bitewings - two radiographic images |
156 |
128 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
250 |
206 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
40 |
40 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
50 |
43 |
$673.37 |