| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,346 |
3,219 |
$85K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,063 |
3,850 |
$65K |
| D1110 |
Prophylaxis - adult |
1,181 |
1,127 |
$43K |
| D4341 |
|
1,233 |
307 |
$36K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
631 |
262 |
$31K |
| D9110 |
|
484 |
444 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
790 |
725 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,774 |
2,572 |
$24K |
| D0274 |
Bitewings - four radiographic images |
1,749 |
1,681 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
720 |
648 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
277 |
136 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
758 |
689 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,007 |
2,270 |
$15K |
| D1120 |
Prophylaxis - child |
588 |
564 |
$13K |
| D4910 |
|
192 |
180 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
63 |
38 |
$6K |
| D1999 |
|
546 |
445 |
$6K |
| D2160 |
|
59 |
38 |
$3K |
| D2140 |
|
28 |
12 |
$1K |