| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,322 |
2,684 |
$91K |
| D1999 |
|
2,523 |
2,005 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
2,643 |
2,107 |
$35K |
| D0272 |
Bitewings - two radiographic images |
2,209 |
1,787 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,327 |
745 |
$23K |
| D0330 |
Panoramic radiographic image |
550 |
466 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
817 |
705 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
926 |
746 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
923 |
747 |
$8K |
| D1120 |
Prophylaxis - child |
303 |
246 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
61 |
49 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
12 |
$404.64 |
| D2140 |
|
17 |
13 |
$341.76 |