| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,308 |
2,046 |
$65K |
| D1999 |
|
3,174 |
2,621 |
$44K |
| D0330 |
Panoramic radiographic image |
884 |
759 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,584 |
1,486 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
898 |
849 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
1,262 |
1,150 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
471 |
469 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,230 |
898 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
930 |
896 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
137 |
95 |
$4K |
| D2140 |
|
157 |
97 |
$3K |
| D1120 |
Prophylaxis - child |
190 |
188 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
172 |
172 |
$3K |
| D2940 |
|
66 |
55 |
$1K |
| D7510 |
|
56 |
56 |
$990.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
28 |
12 |
$577.90 |