| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,509 |
1,161 |
$41K |
| D1999 |
|
2,052 |
1,600 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
653 |
517 |
$19K |
| D0272 |
Bitewings - two radiographic images |
949 |
690 |
$14K |
| D0330 |
Panoramic radiographic image |
380 |
228 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
540 |
416 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
711 |
543 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
640 |
556 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
107 |
77 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
103 |
87 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
31 |
31 |
$1K |