| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,664 |
1,663 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
2,474 |
2,472 |
$54K |
| D0274 |
Bitewings - four radiographic images |
2,298 |
2,297 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
2,607 |
2,604 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
437 |
182 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,404 |
2,404 |
$21K |
| D1120 |
Prophylaxis - child |
543 |
541 |
$18K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
192 |
154 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,181 |
1,178 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
1,754 |
1,754 |
$2K |
| D2140 |
|
18 |
14 |
$852.50 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
13 |
$754.93 |
| D0140 |
Limited oral evaluation - problem focused |
50 |
50 |
$519.16 |