| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,366 |
2,266 |
$67K |
| D1999 |
|
2,732 |
2,600 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,826 |
1,734 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
1,685 |
1,628 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
875 |
836 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
684 |
639 |
$10K |
| D0330 |
Panoramic radiographic image |
232 |
216 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
611 |
590 |
$4K |
| D1120 |
Prophylaxis - child |
120 |
92 |
$2K |
| D2140 |
|
68 |
49 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
157 |
145 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
89 |
82 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
35 |
28 |
$953.64 |