| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,452 |
2,424 |
$115K |
| D0120 |
Periodic oral evaluation - established patient |
4,317 |
4,272 |
$113K |
| D0272 |
Bitewings - two radiographic images |
3,263 |
3,233 |
$75K |
| D1120 |
Prophylaxis - child |
1,701 |
1,682 |
$59K |
| D8670 |
Periodic orthodontic treatment visit |
516 |
363 |
$56K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
19 |
12 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
81 |
49 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
55 |
52 |
$4K |
| D2140 |
|
65 |
54 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
14 |
$2K |
| D0330 |
Panoramic radiographic image |
85 |
85 |
$2K |