| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,218 |
2,910 |
$87K |
| D1999 |
|
4,237 |
3,497 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
3,037 |
2,739 |
$43K |
| D0272 |
Bitewings - two radiographic images |
1,602 |
1,447 |
$23K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
422 |
271 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,380 |
1,200 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,252 |
1,133 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
89 |
87 |
$4K |
| D0330 |
Panoramic radiographic image |
116 |
115 |
$4K |
| D2160 |
|
63 |
41 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
133 |
121 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
63 |
63 |
$1K |