| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
2,530 |
2,212 |
$34K |
| D1110 |
Prophylaxis - adult |
1,136 |
1,067 |
$33K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
558 |
314 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
927 |
873 |
$21K |
| D2160 |
|
245 |
162 |
$13K |
| D0272 |
Bitewings - two radiographic images |
834 |
787 |
$12K |
| D0330 |
Panoramic radiographic image |
236 |
224 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
451 |
429 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
453 |
429 |
$7K |
| D2140 |
|
114 |
56 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
350 |
320 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
268 |
195 |
$2K |
| D1120 |
Prophylaxis - child |
91 |
91 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
28 |
26 |
$582.94 |