| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,560 |
2,092 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
2,339 |
1,872 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,454 |
1,186 |
$21K |
| D1999 |
|
1,303 |
1,071 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,071 |
829 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
715 |
576 |
$11K |
| D1120 |
Prophylaxis - child |
557 |
412 |
$10K |
| D0330 |
Panoramic radiographic image |
196 |
178 |
$6K |
| D2140 |
|
75 |
56 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
238 |
191 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
86 |
69 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
40 |
32 |
$1K |
| D2940 |
|
14 |
12 |
$233.00 |