| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,096 |
7,091 |
$234K |
| D0120 |
Periodic oral evaluation - established patient |
8,688 |
8,681 |
$158K |
| D0274 |
Bitewings - four radiographic images |
5,961 |
5,956 |
$104K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,486 |
8,427 |
$90K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
862 |
506 |
$32K |
| D1120 |
Prophylaxis - child |
1,070 |
1,070 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
1,201 |
1,199 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,919 |
1,919 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
2,206 |
2,200 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
351 |
256 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
851 |
844 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
64 |
54 |
$4K |
| D0272 |
Bitewings - two radiographic images |
185 |
185 |
$2K |
| D1351 |
Sealant - per tooth |
63 |
28 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
22 |
15 |
$1K |
| D4381 |
|
212 |
139 |
$0.00 |