| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
680 |
678 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
994 |
990 |
$54K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,095 |
1,832 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,214 |
1,208 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
302 |
300 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,223 |
1,217 |
$14K |
| D1120 |
Prophylaxis - child |
302 |
298 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
139 |
56 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
610 |
516 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
44 |
14 |
$3K |
| D2952 |
|
17 |
12 |
$2K |