| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,351 |
1,337 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
2,027 |
1,996 |
$64K |
| D1120 |
Prophylaxis - child |
908 |
888 |
$39K |
| D1206 |
Topical application of fluoride varnish |
1,538 |
1,510 |
$38K |
| D0274 |
Bitewings - four radiographic images |
863 |
862 |
$34K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
284 |
182 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
288 |
284 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
221 |
221 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
461 |
447 |
$9K |
| D0272 |
Bitewings - two radiographic images |
255 |
248 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
42 |
24 |
$7K |
| D0330 |
Panoramic radiographic image |
59 |
59 |
$5K |