| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,895 |
1,714 |
$53K |
| D1999 |
|
1,881 |
1,665 |
$25K |
| D0330 |
Panoramic radiographic image |
770 |
693 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,132 |
1,002 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,301 |
1,167 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
763 |
698 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,523 |
549 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
583 |
517 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
242 |
205 |
$3K |
| D1351 |
Sealant - per tooth |
114 |
13 |
$2K |
| D1120 |
Prophylaxis - child |
65 |
53 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
15 |
12 |
$725.60 |