| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,140 |
1,122 |
$32K |
| D1999 |
|
1,728 |
1,631 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
921 |
904 |
$14K |
| D0330 |
Panoramic radiographic image |
452 |
445 |
$13K |
| D0272 |
Bitewings - two radiographic images |
791 |
779 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
285 |
282 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
263 |
262 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
57 |
56 |
$1K |
| D1120 |
Prophylaxis - child |
57 |
57 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
18 |
12 |
$876.04 |
| D9995 |
|
35 |
35 |
$488.00 |