| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,755 |
1,518 |
$49K |
| D1999 |
|
2,194 |
1,893 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,394 |
1,216 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
735 |
665 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
1,103 |
943 |
$16K |
| D0330 |
Panoramic radiographic image |
476 |
431 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
167 |
110 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
968 |
842 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
752 |
564 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
176 |
150 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
141 |
129 |
$2K |
| D1120 |
Prophylaxis - child |
14 |
12 |
$240.00 |