| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,318 |
2,999 |
$95K |
| D1999 |
|
3,801 |
3,293 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
2,666 |
2,403 |
$38K |
| D0272 |
Bitewings - two radiographic images |
2,400 |
2,199 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,025 |
955 |
$22K |
| D0330 |
Panoramic radiographic image |
535 |
479 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
874 |
778 |
$12K |
| D1120 |
Prophylaxis - child |
256 |
253 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
104 |
93 |
$3K |
| D2140 |
|
15 |
12 |
$322.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$144.70 |