| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4342 |
|
4,960 |
1,918 |
$153K |
| D1110 |
Prophylaxis - adult |
3,321 |
3,311 |
$125K |
| D0120 |
Periodic oral evaluation - established patient |
5,280 |
5,269 |
$109K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,563 |
675 |
$101K |
| D0210 |
Intraoral - complete series of radiographic images |
4,305 |
4,293 |
$78K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,757 |
3,750 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
3,516 |
3,511 |
$38K |
| D2140 |
|
368 |
184 |
$14K |
| D2161 |
|
91 |
64 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
459 |
459 |
$5K |
| D0274 |
Bitewings - four radiographic images |
211 |
211 |
$4K |
| D0272 |
Bitewings - two radiographic images |
314 |
314 |
$4K |
| D2160 |
|
37 |
26 |
$2K |
| D2335 |
|
23 |
12 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
13 |
$2K |
| D1120 |
Prophylaxis - child |
38 |
38 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
18 |
18 |
$408.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$118.16 |
| D1999 |
|
132 |
103 |
$0.00 |
| D1310 |
|
26 |
26 |
$0.00 |