| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,279 |
4,028 |
$118K |
| D1999 |
|
6,278 |
5,749 |
$92K |
| D0120 |
Periodic oral evaluation - established patient |
3,641 |
3,418 |
$53K |
| D0330 |
Panoramic radiographic image |
1,495 |
1,424 |
$44K |
| D0272 |
Bitewings - two radiographic images |
2,983 |
2,822 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,381 |
1,319 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,608 |
1,523 |
$22K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
434 |
323 |
$21K |
| D1120 |
Prophylaxis - child |
573 |
556 |
$11K |
| D2160 |
|
133 |
106 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
227 |
222 |
$4K |
| D2140 |
|
111 |
78 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
387 |
355 |
$3K |
| D2940 |
|
14 |
13 |
$375.00 |