| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
916 |
475 |
$28K |
| D1110 |
Prophylaxis - adult |
1,037 |
802 |
$24K |
| D2140 |
|
538 |
280 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
691 |
502 |
$11K |
| D0330 |
Panoramic radiographic image |
384 |
279 |
$10K |
| D0272 |
Bitewings - two radiographic images |
747 |
611 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
641 |
505 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
727 |
600 |
$8K |
| D1120 |
Prophylaxis - child |
268 |
218 |
$5K |
| D2160 |
|
85 |
57 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
94 |
56 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
160 |
112 |
$773.67 |
| D0140 |
Limited oral evaluation - problem focused |
37 |
27 |
$481.58 |