| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2332 |
|
563 |
93 |
$18K |
| D1110 |
Prophylaxis - adult |
590 |
456 |
$13K |
| D1999 |
|
879 |
746 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
506 |
360 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
252 |
55 |
$5K |
| D0272 |
Bitewings - two radiographic images |
315 |
242 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
367 |
306 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
284 |
230 |
$4K |
| D1120 |
Prophylaxis - child |
163 |
136 |
$3K |
| D2140 |
|
95 |
47 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
211 |
161 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
42 |
13 |
$1K |
| D2330 |
|
39 |
12 |
$855.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
19 |
15 |
$67.40 |