| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,524 |
2,519 |
$117K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,641 |
3,635 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,751 |
1,746 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
2,024 |
2,022 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
979 |
457 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,422 |
1,417 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
419 |
263 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,259 |
2,207 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
364 |
364 |
$21K |
| D1120 |
Prophylaxis - child |
502 |
501 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,854 |
1,658 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
403 |
388 |
$14K |
| D4910 |
|
88 |
88 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
65 |
47 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
63 |
42 |
$4K |
| D0601 |
|
363 |
362 |
$4K |
| D2160 |
|
36 |
27 |
$3K |
| D1999 |
|
334 |
301 |
$2K |
| D1330 |
|
38 |
38 |
$20.00 |