| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,488 |
4,709 |
$151K |
| D1999 |
|
5,561 |
4,726 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
4,669 |
4,024 |
$64K |
| D0330 |
Panoramic radiographic image |
1,962 |
1,632 |
$58K |
| D0272 |
Bitewings - two radiographic images |
3,730 |
3,156 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,509 |
1,252 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,828 |
1,467 |
$26K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
318 |
221 |
$12K |
| D1120 |
Prophylaxis - child |
314 |
252 |
$6K |
| D2160 |
|
49 |
40 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
85 |
84 |
$439.18 |