| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,626 |
3,864 |
$131K |
| D1999 |
|
4,770 |
3,665 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
4,242 |
3,530 |
$57K |
| D0330 |
Panoramic radiographic image |
1,768 |
1,534 |
$53K |
| D0272 |
Bitewings - two radiographic images |
2,898 |
2,471 |
$42K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,167 |
706 |
$41K |
| D2140 |
|
782 |
405 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
906 |
737 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
984 |
801 |
$14K |
| D2160 |
|
106 |
79 |
$5K |
| D1120 |
Prophylaxis - child |
137 |
106 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
217 |
185 |
$1K |
| D2335 |
|
17 |
12 |
$1K |