| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,991 |
1,794 |
$55K |
| D1999 |
|
1,520 |
1,353 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
1,514 |
1,370 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
893 |
812 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,058 |
957 |
$15K |
| D0330 |
Panoramic radiographic image |
412 |
378 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
848 |
542 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
217 |
127 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
395 |
350 |
$6K |
| D2140 |
|
230 |
115 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
740 |
587 |
$4K |
| D1120 |
Prophylaxis - child |
94 |
90 |
$2K |