| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,775 |
3,437 |
$98K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,148 |
1,302 |
$91K |
| D1999 |
|
5,923 |
4,769 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
3,355 |
3,056 |
$46K |
| D0272 |
Bitewings - two radiographic images |
2,471 |
2,250 |
$35K |
| D0330 |
Panoramic radiographic image |
976 |
897 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,539 |
1,410 |
$22K |
| D2140 |
|
675 |
439 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
990 |
920 |
$19K |
| D1120 |
Prophylaxis - child |
645 |
599 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
38 |
30 |
$250.52 |
| D0140 |
Limited oral evaluation - problem focused |
26 |
25 |
$59.04 |