| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,685 |
1,657 |
$146K |
| D0120 |
Periodic oral evaluation - established patient |
1,873 |
1,845 |
$111K |
| D4910 |
|
1,018 |
997 |
$78K |
| D4341 |
|
944 |
318 |
$66K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,407 |
1,382 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
483 |
480 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
380 |
378 |
$23K |
| D1120 |
Prophylaxis - child |
445 |
445 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,089 |
1,083 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
517 |
503 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
82 |
58 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
393 |
393 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
52 |
39 |
$3K |
| D2330 |
|
28 |
15 |
$2K |
| D9430 |
|
50 |
50 |
$2K |
| D2140 |
|
15 |
12 |
$819.00 |
| D1206 |
Topical application of fluoride varnish |
34 |
34 |
$272.00 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$259.20 |