| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,507 |
3,369 |
$188K |
| D0274 |
Bitewings - four radiographic images |
2,731 |
2,606 |
$99K |
| D9450 |
|
3,512 |
2,846 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
3,657 |
3,535 |
$85K |
| D0220 |
Intraoral - periapical first radiographic image |
3,285 |
3,128 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,420 |
2,908 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
556 |
543 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,332 |
1,297 |
$37K |
| D1120 |
Prophylaxis - child |
529 |
523 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
226 |
213 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
78 |
52 |
$8K |
| D2951 |
|
168 |
104 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
33 |
26 |
$2K |
| D9110 |
|
28 |
25 |
$1K |
| D1999 |
|
42 |
39 |
$0.00 |