| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,320 |
1,302 |
$39K |
| D0330 |
Panoramic radiographic image |
1,105 |
1,095 |
$34K |
| D5110 |
|
91 |
89 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,309 |
1,292 |
$23K |
| D5211 |
|
58 |
58 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
639 |
636 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
1,143 |
1,123 |
$11K |
| D0272 |
Bitewings - two radiographic images |
544 |
536 |
$7K |
| D2140 |
|
284 |
149 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
591 |
577 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
499 |
474 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
34 |
28 |
$1K |
| D2330 |
|
17 |
12 |
$560.00 |
| D0110 |
|
18 |
18 |
$0.00 |