| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,968 |
5,113 |
$155K |
| D1999 |
|
5,790 |
4,703 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
5,097 |
4,378 |
$68K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,391 |
936 |
$48K |
| D0272 |
Bitewings - two radiographic images |
3,406 |
2,943 |
$48K |
| D0330 |
Panoramic radiographic image |
1,315 |
1,157 |
$39K |
| D2160 |
|
414 |
327 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
603 |
527 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
852 |
764 |
$11K |
| D2335 |
|
117 |
69 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,011 |
868 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,184 |
778 |
$4K |
| D2140 |
|
115 |
75 |
$3K |