| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,680 |
1,375 |
$50K |
| D1999 |
|
2,630 |
2,176 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,676 |
1,355 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,099 |
889 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
562 |
431 |
$8K |
| D0330 |
Panoramic radiographic image |
178 |
178 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
215 |
181 |
$5K |
| D1120 |
Prophylaxis - child |
223 |
164 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
58 |
39 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
19 |
15 |
$163.40 |