| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
735 |
676 |
$18K |
| D1999 |
|
759 |
664 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
295 |
213 |
$7K |
| D0272 |
Bitewings - two radiographic images |
556 |
499 |
$7K |
| D0330 |
Panoramic radiographic image |
282 |
250 |
$7K |
| D2160 |
|
216 |
154 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
317 |
282 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
233 |
208 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
160 |
152 |
$2K |
| D2940 |
|
111 |
77 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
354 |
263 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
273 |
244 |
$1K |
| D2161 |
|
21 |
14 |
$628.00 |
| D2140 |
|
19 |
15 |
$374.80 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$194.40 |