| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,874 |
1,802 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
2,174 |
2,097 |
$54K |
| D0330 |
Panoramic radiographic image |
261 |
257 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
153 |
88 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
311 |
292 |
$13K |
| D0272 |
Bitewings - two radiographic images |
698 |
654 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
328 |
309 |
$12K |
| D1120 |
Prophylaxis - child |
438 |
410 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
575 |
571 |
$9K |
| D0274 |
Bitewings - four radiographic images |
223 |
220 |
$7K |
| D2140 |
|
102 |
37 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
460 |
420 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
66 |
27 |
$5K |
| D2332 |
|
31 |
15 |
$3K |
| D2331 |
|
26 |
12 |
$2K |
| D1351 |
Sealant - per tooth |
72 |
13 |
$2K |