| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
805 |
670 |
$19K |
| D0272 |
Bitewings - two radiographic images |
642 |
530 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
263 |
162 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
644 |
527 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
428 |
350 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
387 |
316 |
$6K |
| D1120 |
Prophylaxis - child |
284 |
234 |
$5K |
| D0330 |
Panoramic radiographic image |
146 |
143 |
$3K |
| D2160 |
|
89 |
71 |
$3K |
| D2140 |
|
25 |
15 |
$540.00 |
| D0220 |
Intraoral - periapical first radiographic image |
45 |
26 |
$212.40 |
| D1999 |
|
102 |
96 |
$35.00 |