| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,190 |
4,290 |
$154K |
| D1999 |
|
7,316 |
5,579 |
$108K |
| D0330 |
Panoramic radiographic image |
1,686 |
1,391 |
$56K |
| D0272 |
Bitewings - two radiographic images |
3,709 |
3,069 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,274 |
1,956 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
3,513 |
2,860 |
$50K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
658 |
489 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,474 |
1,226 |
$21K |
| D1120 |
Prophylaxis - child |
590 |
488 |
$11K |
| D2160 |
|
87 |
79 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
42 |
41 |
$2K |
| D2140 |
|
14 |
12 |
$300.40 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$62.80 |