| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,936 |
2,567 |
$71K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,571 |
892 |
$65K |
| D1999 |
|
3,912 |
3,372 |
$55K |
| D0330 |
Panoramic radiographic image |
1,895 |
1,645 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,039 |
1,770 |
$38K |
| D0272 |
Bitewings - two radiographic images |
2,578 |
2,279 |
$34K |
| D2140 |
|
860 |
468 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
1,768 |
1,550 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,293 |
1,108 |
$17K |
| D1120 |
Prophylaxis - child |
635 |
553 |
$10K |
| D2160 |
|
108 |
83 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
39 |
35 |
$789.36 |
| D0220 |
Intraoral - periapical first radiographic image |
65 |
59 |
$531.56 |