| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,028 |
3,573 |
$118K |
| D1999 |
|
4,630 |
3,990 |
$69K |
| D0272 |
Bitewings - two radiographic images |
2,838 |
2,543 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
2,626 |
2,310 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,628 |
1,474 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,109 |
2,596 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,805 |
2,574 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
639 |
550 |
$9K |
| D0330 |
Panoramic radiographic image |
247 |
170 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
55 |
42 |
$3K |
| D2140 |
|
36 |
29 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
41 |
38 |
$558.07 |
| D1120 |
Prophylaxis - child |
31 |
26 |
$524.80 |