| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,382 |
2,077 |
$60K |
| D1999 |
|
2,328 |
1,868 |
$35K |
| D0272 |
Bitewings - two radiographic images |
1,932 |
1,720 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
1,904 |
1,620 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
881 |
848 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
793 |
738 |
$11K |
| D0330 |
Panoramic radiographic image |
253 |
168 |
$7K |
| D1120 |
Prophylaxis - child |
352 |
331 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
116 |
72 |
$3K |
| D1351 |
Sealant - per tooth |
149 |
18 |
$2K |
| D2140 |
|
41 |
31 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
124 |
107 |
$693.11 |
| D0140 |
Limited oral evaluation - problem focused |
17 |
17 |
$134.19 |