| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,382 |
1,134 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,371 |
1,104 |
$13K |
| D0272 |
Bitewings - two radiographic images |
1,032 |
844 |
$13K |
| D1999 |
|
653 |
502 |
$9K |
| D0330 |
Panoramic radiographic image |
361 |
308 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
418 |
340 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
153 |
99 |
$3K |
| D1120 |
Prophylaxis - child |
248 |
197 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
154 |
128 |
$2K |
| D2140 |
|
93 |
59 |
$2K |
| D2331 |
|
21 |
12 |
$647.50 |
| D0220 |
Intraoral - periapical first radiographic image |
143 |
123 |
$646.20 |
| D2160 |
|
15 |
14 |
$425.90 |
| D0140 |
Limited oral evaluation - problem focused |
29 |
26 |
$298.80 |
| D0230 |
Intraoral - periapical each additional radiographic image |
28 |
26 |
$97.20 |