| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
986 |
958 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,722 |
1,665 |
$43K |
| D1206 |
Topical application of fluoride varnish |
1,310 |
1,263 |
$25K |
| D1120 |
Prophylaxis - child |
728 |
708 |
$24K |
| D0272 |
Bitewings - two radiographic images |
718 |
696 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
754 |
723 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,170 |
635 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
44 |
25 |
$3K |
| D0274 |
Bitewings - four radiographic images |
133 |
133 |
$3K |
| D0603 |
|
379 |
365 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$1K |
| D0602 |
|
109 |
109 |
$475.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$438.90 |
| D0601 |
|
14 |
14 |
$66.37 |
| D1999 |
|
130 |
120 |
$0.00 |