| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,487 |
3,380 |
$97K |
| D1999 |
|
6,423 |
6,186 |
$95K |
| D0120 |
Periodic oral evaluation - established patient |
3,917 |
3,820 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,101 |
275 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,034 |
2,971 |
$44K |
| D1120 |
Prophylaxis - child |
2,197 |
2,153 |
$43K |
| D0272 |
Bitewings - two radiographic images |
2,856 |
2,765 |
$41K |
| D1351 |
Sealant - per tooth |
2,354 |
399 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,626 |
1,573 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,378 |
3,210 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
3,074 |
2,981 |
$25K |
| D2330 |
|
360 |
99 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
274 |
201 |
$12K |
| D2332 |
|
187 |
71 |
$11K |
| D2160 |
|
73 |
54 |
$4K |
| D2335 |
|
58 |
24 |
$4K |
| D2331 |
|
84 |
43 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
28 |
25 |
$491.14 |