| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,369 |
1,310 |
$47K |
| D1999 |
|
2,109 |
1,920 |
$30K |
| D0330 |
Panoramic radiographic image |
588 |
553 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
772 |
729 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,034 |
980 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
278 |
163 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
609 |
591 |
$10K |
| D2140 |
|
104 |
65 |
$4K |
| D2160 |
|
23 |
13 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
88 |
80 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
14 |
$120.40 |