| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
780 |
750 |
$20K |
| D1999 |
|
1,123 |
1,067 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
695 |
671 |
$10K |
| D0330 |
Panoramic radiographic image |
352 |
341 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
901 |
574 |
$7K |
| D0272 |
Bitewings - two radiographic images |
514 |
500 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
277 |
265 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
105 |
85 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
159 |
154 |
$2K |
| D2160 |
|
36 |
19 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
211 |
202 |
$2K |
| D1120 |
Prophylaxis - child |
76 |
74 |
$1K |
| D2140 |
|
18 |
13 |
$589.39 |