| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,323 |
1,192 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
2,233 |
1,984 |
$56K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
532 |
309 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,827 |
1,614 |
$34K |
| D1120 |
Prophylaxis - child |
633 |
537 |
$21K |
| D0272 |
Bitewings - two radiographic images |
698 |
593 |
$16K |
| D2140 |
|
194 |
86 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
229 |
191 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
123 |
97 |
$2K |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$930.50 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$222.30 |