| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,309 |
2,180 |
$60K |
| D1999 |
|
1,582 |
1,501 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
1,509 |
1,427 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,300 |
1,232 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
610 |
576 |
$11K |
| D0330 |
Panoramic radiographic image |
372 |
354 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
228 |
222 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
59 |
41 |
$2K |
| D2140 |
|
47 |
36 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
37 |
36 |
$254.64 |
| D1120 |
Prophylaxis - child |
14 |
13 |
$181.80 |