| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
1,353 |
1,286 |
$20K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
372 |
271 |
$18K |
| D1110 |
Prophylaxis - adult |
495 |
476 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
632 |
601 |
$12K |
| D1120 |
Prophylaxis - child |
555 |
534 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
697 |
671 |
$10K |
| D0272 |
Bitewings - two radiographic images |
637 |
607 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,614 |
346 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
333 |
323 |
$5K |
| D0330 |
Panoramic radiographic image |
130 |
124 |
$4K |
| D2140 |
|
82 |
53 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
377 |
329 |
$3K |
| D2160 |
|
36 |
26 |
$2K |