| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
832 |
803 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
859 |
826 |
$10K |
| D1999 |
|
357 |
337 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
165 |
163 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
77 |
67 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
205 |
199 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
159 |
149 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
249 |
233 |
$2K |
| D1120 |
Prophylaxis - child |
76 |
75 |
$1K |
| D0272 |
Bitewings - two radiographic images |
35 |
35 |
$504.29 |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$469.60 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
16 |
12 |
$407.30 |