| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,550 |
3,243 |
$102K |
| D1999 |
|
3,971 |
3,757 |
$60K |
| D0330 |
Panoramic radiographic image |
1,649 |
1,524 |
$50K |
| D0272 |
Bitewings - two radiographic images |
2,957 |
2,685 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
2,957 |
2,650 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,645 |
1,520 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,758 |
1,557 |
$25K |
| D1120 |
Prophylaxis - child |
811 |
712 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
293 |
206 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
141 |
138 |
$886.48 |
| D0230 |
Intraoral - periapical each additional radiographic image |
35 |
30 |
$529.48 |