| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2335 |
|
693 |
359 |
$84K |
| D2332 |
|
713 |
404 |
$75K |
| D2331 |
|
293 |
189 |
$25K |
| D1110 |
Prophylaxis - adult |
701 |
693 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
528 |
518 |
$19K |
| D1206 |
Topical application of fluoride varnish |
891 |
884 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
269 |
268 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
168 |
99 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
221 |
103 |
$12K |
| D2394 |
|
98 |
67 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
452 |
449 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
127 |
78 |
$8K |
| D2330 |
|
124 |
69 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
130 |
122 |
$3K |
| D2161 |
|
29 |
25 |
$3K |
| D2160 |
|
18 |
12 |
$1K |
| D1120 |
Prophylaxis - child |
24 |
24 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
16 |
12 |
$994.08 |
| D0230 |
Intraoral - periapical each additional radiographic image |
48 |
12 |
$486.88 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$343.68 |