| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,353 |
1,336 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
2,210 |
2,177 |
$62K |
| D1120 |
Prophylaxis - child |
995 |
977 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,430 |
2,397 |
$35K |
| D0274 |
Bitewings - four radiographic images |
506 |
493 |
$17K |
| D0330 |
Panoramic radiographic image |
184 |
184 |
$11K |
| D0272 |
Bitewings - two radiographic images |
280 |
270 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
47 |
18 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
25 |
25 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
75 |
74 |
$2K |
| D2140 |
|
25 |
15 |
$2K |
| D0603 |
|
2,631 |
2,596 |
$0.00 |