| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,123 |
1,121 |
$95K |
| D0120 |
Periodic oral evaluation - established patient |
1,118 |
1,112 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,657 |
1,651 |
$21K |
| D0274 |
Bitewings - four radiographic images |
959 |
958 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,370 |
1,528 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
166 |
166 |
$10K |
| D1120 |
Prophylaxis - child |
121 |
117 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
160 |
159 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21 |
14 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
20 |
12 |
$1K |
| D9430 |
|
39 |
37 |
$1K |
| D0350 |
|
21 |
12 |
$192.00 |
| D0272 |
Bitewings - two radiographic images |
17 |
15 |
$140.00 |