| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,263 |
1,182 |
$34K |
| D1999 |
|
1,858 |
1,694 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,081 |
1,015 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
816 |
764 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
486 |
441 |
$10K |
| D0330 |
Panoramic radiographic image |
300 |
281 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
195 |
132 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
976 |
868 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
421 |
339 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
161 |
138 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
94 |
83 |
$1K |
| D2160 |
|
22 |
15 |
$1K |
| D1120 |
Prophylaxis - child |
49 |
47 |
$707.43 |