| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,871 |
1,402 |
$62K |
| D1999 |
|
2,797 |
2,173 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,754 |
1,321 |
$28K |
| D0330 |
Panoramic radiographic image |
539 |
366 |
$19K |
| D0272 |
Bitewings - two radiographic images |
791 |
700 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
656 |
483 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
788 |
353 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
207 |
177 |
$5K |
| D1120 |
Prophylaxis - child |
187 |
138 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
388 |
339 |
$3K |
| D2160 |
|
16 |
12 |
$917.24 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
16 |
12 |
$774.38 |