| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,078 |
2,055 |
$294K |
| D0272 |
Bitewings - two radiographic images |
894 |
893 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
69 |
38 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
110 |
59 |
$3K |
| D1110 |
Prophylaxis - adult |
214 |
209 |
$2K |
| D0274 |
Bitewings - four radiographic images |
838 |
831 |
$2K |
| D1206 |
Topical application of fluoride varnish |
1,716 |
1,700 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,071 |
2,049 |
$2K |
| D1120 |
Prophylaxis - child |
1,539 |
1,532 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
2,187 |
2,156 |
$2K |
| D2140 |
|
17 |
12 |
$420.96 |
| D0330 |
Panoramic radiographic image |
74 |
73 |
$172.04 |