| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
704 |
612 |
$20K |
| D1999 |
|
942 |
763 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
697 |
574 |
$9K |
| D0272 |
Bitewings - two radiographic images |
314 |
283 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
156 |
147 |
$2K |
| D0330 |
Panoramic radiographic image |
65 |
64 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
76 |
74 |
$1K |
| D1120 |
Prophylaxis - child |
62 |
58 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
17 |
12 |
$724.06 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
12 |
$101.32 |