| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
446 |
411 |
$9K |
| D0272 |
Bitewings - two radiographic images |
391 |
356 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
339 |
311 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
252 |
228 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
275 |
250 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
105 |
70 |
$2K |
| D0330 |
Panoramic radiographic image |
96 |
90 |
$2K |
| D1120 |
Prophylaxis - child |
145 |
133 |
$2K |
| D2160 |
|
56 |
42 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
220 |
190 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
72 |
70 |
$714.60 |
| D0230 |
Intraoral - periapical each additional radiographic image |
106 |
85 |
$385.20 |