| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,904 |
1,675 |
$55K |
| D1999 |
|
2,318 |
1,986 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,683 |
1,525 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,432 |
1,207 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
807 |
703 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,081 |
872 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,010 |
850 |
$7K |
| D0330 |
Panoramic radiographic image |
192 |
167 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
188 |
88 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
351 |
280 |
$6K |
| D1120 |
Prophylaxis - child |
282 |
232 |
$5K |
| D2140 |
|
151 |
63 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$533.82 |