| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,558 |
1,122 |
$45K |
| D1999 |
|
2,128 |
1,577 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
1,428 |
1,007 |
$22K |
| D0272 |
Bitewings - two radiographic images |
854 |
624 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
388 |
289 |
$6K |
| D0330 |
Panoramic radiographic image |
185 |
122 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
187 |
166 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
32 |
25 |
$2K |
| D1120 |
Prophylaxis - child |
61 |
48 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$103.20 |