| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,844 |
2,609 |
$75K |
| D1999 |
|
3,217 |
2,940 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,423 |
1,256 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
1,897 |
1,754 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,550 |
1,405 |
$22K |
| D0330 |
Panoramic radiographic image |
532 |
451 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
897 |
778 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
121 |
81 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
514 |
259 |
$4K |
| D1120 |
Prophylaxis - child |
246 |
199 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
391 |
382 |
$3K |
| D1351 |
Sealant - per tooth |
186 |
24 |
$3K |
| D2140 |
|
51 |
29 |
$2K |