| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,073 |
1,954 |
$55K |
| D1999 |
|
2,635 |
2,267 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,732 |
1,643 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,249 |
1,177 |
$18K |
| D0330 |
Panoramic radiographic image |
520 |
505 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
64 |
54 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
188 |
173 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
56 |
55 |
$763.40 |
| D1208 |
Topical application of fluoride, excluding varnish |
38 |
38 |
$514.13 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$169.85 |