| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,466 |
4,466 |
$204K |
| D0274 |
Bitewings - four radiographic images |
4,624 |
4,624 |
$106K |
| D0120 |
Periodic oral evaluation - established patient |
4,189 |
4,189 |
$96K |
| D0220 |
Intraoral - periapical first radiographic image |
5,923 |
5,871 |
$65K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
693 |
632 |
$63K |
| D2160 |
|
550 |
503 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,938 |
4,936 |
$54K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
516 |
463 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,432 |
1,432 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
140 |
125 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
446 |
446 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
683 |
662 |
$7K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
14 |
13 |
$7K |
| D1120 |
Prophylaxis - child |
98 |
98 |
$3K |
| D9996 |
|
49 |
47 |
$615.44 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
12 |
12 |
$534.82 |