| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,773 |
1,678 |
$48K |
| D1999 |
|
1,961 |
1,597 |
$26K |
| D0330 |
Panoramic radiographic image |
515 |
481 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
632 |
593 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
903 |
853 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
344 |
321 |
$5K |
| D1120 |
Prophylaxis - child |
86 |
80 |
$1K |
| D0272 |
Bitewings - two radiographic images |
76 |
71 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
31 |
24 |
$829.81 |
| D2140 |
|
39 |
27 |
$829.20 |
| D0220 |
Intraoral - periapical first radiographic image |
125 |
121 |
$677.32 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$157.02 |