| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
4,806 |
4,328 |
$70K |
| D1110 |
Prophylaxis - adult |
2,480 |
2,379 |
$68K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
873 |
566 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,991 |
1,924 |
$30K |
| D0330 |
Panoramic radiographic image |
893 |
853 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,634 |
1,572 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
661 |
633 |
$15K |
| D2140 |
|
242 |
167 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
541 |
532 |
$8K |
| D2160 |
|
121 |
88 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
172 |
157 |
$1K |
| D1120 |
Prophylaxis - child |
25 |
25 |
$460.80 |
| D0140 |
Limited oral evaluation - problem focused |
26 |
26 |
$446.27 |