| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,131 |
1,920 |
$54K |
| D0330 |
Panoramic radiographic image |
1,079 |
970 |
$30K |
| D1999 |
|
2,218 |
2,081 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,890 |
1,691 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
1,494 |
1,327 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
973 |
876 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,918 |
378 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
489 |
405 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
170 |
87 |
$5K |
| D1120 |
Prophylaxis - child |
262 |
219 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
446 |
374 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
189 |
165 |
$2K |
| D2140 |
|
46 |
24 |
$1K |