| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,881 |
2,586 |
$81K |
| D1999 |
|
3,261 |
2,861 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,425 |
1,306 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
1,726 |
1,529 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,516 |
1,385 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
298 |
269 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
194 |
124 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
409 |
375 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
824 |
787 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
264 |
189 |
$1K |
| D0330 |
Panoramic radiographic image |
28 |
28 |
$863.02 |
| D1120 |
Prophylaxis - child |
48 |
48 |
$777.60 |
| D2140 |
|
35 |
27 |
$756.00 |
| D0140 |
Limited oral evaluation - problem focused |
41 |
41 |
$636.76 |