| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,842 |
4,840 |
$191K |
| D0120 |
Periodic oral evaluation - established patient |
8,754 |
8,752 |
$187K |
| D1120 |
Prophylaxis - child |
4,140 |
4,138 |
$136K |
| D0274 |
Bitewings - four radiographic images |
4,781 |
4,781 |
$102K |
| D0220 |
Intraoral - periapical first radiographic image |
10,394 |
10,298 |
$100K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,182 |
5,181 |
$59K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,007 |
8,989 |
$53K |
| D0272 |
Bitewings - two radiographic images |
1,881 |
1,881 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
368 |
336 |
$22K |
| D1351 |
Sealant - per tooth |
192 |
127 |
$17K |
| D9990 |
|
334 |
327 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
183 |
171 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
14 |
14 |
$878.16 |
| D0140 |
Limited oral evaluation - problem focused |
50 |
49 |
$512.62 |
| D0210 |
Intraoral - complete series of radiographic images |
39 |
39 |
$439.24 |