| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,081 |
1,070 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
1,156 |
1,146 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,040 |
988 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
405 |
401 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,555 |
1,511 |
$18K |
| D1120 |
Prophylaxis - child |
499 |
499 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
253 |
250 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
72 |
50 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
54 |
25 |
$4K |
| D9430 |
|
45 |
41 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
130 |
130 |
$1K |