| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,090 |
1,026 |
$28K |
| D1999 |
|
969 |
885 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
860 |
799 |
$9K |
| D0272 |
Bitewings - two radiographic images |
627 |
583 |
$8K |
| D0330 |
Panoramic radiographic image |
242 |
233 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
249 |
229 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
94 |
50 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
124 |
115 |
$2K |
| D2140 |
|
90 |
57 |
$2K |
| D1120 |
Prophylaxis - child |
82 |
72 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
15 |
15 |
$296.73 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$93.68 |