| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,905 |
1,592 |
$55K |
| D1999 |
|
3,266 |
2,662 |
$49K |
| D0272 |
Bitewings - two radiographic images |
1,434 |
1,204 |
$21K |
| D0330 |
Panoramic radiographic image |
627 |
541 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
866 |
732 |
$19K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
402 |
213 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
1,109 |
923 |
$16K |
| D2160 |
|
120 |
74 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
242 |
220 |
$3K |
| D2140 |
|
35 |
24 |
$1K |
| D1120 |
Prophylaxis - child |
31 |
28 |
$545.60 |
| D0220 |
Intraoral - periapical first radiographic image |
60 |
40 |
$493.80 |