| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,773 |
1,711 |
$79K |
| D2330 |
|
1,068 |
521 |
$77K |
| D0140 |
Limited oral evaluation - problem focused |
1,319 |
1,159 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,508 |
1,465 |
$32K |
| D0272 |
Bitewings - two radiographic images |
939 |
899 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
354 |
194 |
$20K |
| D2332 |
|
105 |
52 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
298 |
288 |
$11K |
| D2331 |
|
132 |
93 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,200 |
642 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
767 |
612 |
$8K |
| D2335 |
|
29 |
15 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
23 |
13 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
13 |
$266.69 |