| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,786 |
2,779 |
$138K |
| D0120 |
Periodic oral evaluation - established patient |
4,283 |
4,273 |
$97K |
| D1120 |
Prophylaxis - child |
2,079 |
2,075 |
$73K |
| D0272 |
Bitewings - two radiographic images |
3,814 |
3,806 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,502 |
3,495 |
$57K |
| D0330 |
Panoramic radiographic image |
1,189 |
1,181 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
2,513 |
2,274 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
312 |
310 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
67 |
67 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
15 |
12 |
$1K |
| D0240 |
|
52 |
52 |
$984.88 |