| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
985 |
983 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,246 |
1,244 |
$24K |
| D0274 |
Bitewings - four radiographic images |
319 |
318 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
96 |
59 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
75 |
75 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
267 |
267 |
$4K |
| D1120 |
Prophylaxis - child |
81 |
81 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
36 |
24 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
40 |
27 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
162 |
161 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$319.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
53 |
53 |
$254.20 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$239.80 |
| D1206 |
Topical application of fluoride varnish |
14 |
14 |
$211.25 |