| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,137 |
3,464 |
$120K |
| D1999 |
|
4,530 |
3,758 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
3,348 |
2,682 |
$50K |
| D0272 |
Bitewings - two radiographic images |
2,763 |
2,320 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,470 |
1,376 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,669 |
1,403 |
$24K |
| D1120 |
Prophylaxis - child |
629 |
544 |
$12K |
| D0330 |
Panoramic radiographic image |
320 |
304 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
60 |
39 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
38 |
36 |
$599.94 |
| D0220 |
Intraoral - periapical first radiographic image |
27 |
25 |
$216.75 |
| D0230 |
Intraoral - periapical each additional radiographic image |
13 |
12 |
$106.40 |