| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,021 |
1,618 |
$56K |
| D1999 |
|
2,793 |
2,260 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,741 |
1,356 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,301 |
1,052 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
502 |
411 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
211 |
119 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
606 |
461 |
$9K |
| D0330 |
Panoramic radiographic image |
249 |
185 |
$8K |
| D1120 |
Prophylaxis - child |
169 |
114 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
120 |
101 |
$996.01 |
| D0230 |
Intraoral - periapical each additional radiographic image |
81 |
65 |
$649.08 |