| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,802 |
2,394 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
2,312 |
1,969 |
$31K |
| D0330 |
Panoramic radiographic image |
1,060 |
931 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,888 |
1,604 |
$26K |
| D1999 |
|
1,790 |
1,642 |
$25K |
| D2140 |
|
461 |
227 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
535 |
461 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
115 |
75 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
130 |
109 |
$2K |
| D7250 |
|
21 |
13 |
$1K |
| D1120 |
Prophylaxis - child |
40 |
35 |
$651.20 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$153.36 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$68.92 |