| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,191 |
3,128 |
$135K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,639 |
1,069 |
$118K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,785 |
3,713 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
2,992 |
2,950 |
$71K |
| D0330 |
Panoramic radiographic image |
1,441 |
1,391 |
$59K |
| D2140 |
|
922 |
648 |
$54K |
| D2160 |
|
450 |
283 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,355 |
1,328 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
983 |
957 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,500 |
1,474 |
$24K |
| D1120 |
Prophylaxis - child |
375 |
371 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
176 |
97 |
$8K |
| D1206 |
Topical application of fluoride varnish |
111 |
108 |
$2K |
| D4346 |
|
38 |
38 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
26 |
26 |
$596.86 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$166.65 |
| D1999 |
|
332 |
324 |
$0.00 |