| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,526 |
4,410 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
4,270 |
3,972 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,440 |
4,333 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,344 |
1,233 |
$13K |
| D1120 |
Prophylaxis - child |
1,606 |
1,564 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
3,232 |
3,040 |
$12K |
| D0274 |
Bitewings - four radiographic images |
2,117 |
2,109 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
623 |
581 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,547 |
1,545 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
113 |
110 |
$2K |
| D0272 |
Bitewings - two radiographic images |
517 |
502 |
$2K |
| D9110 |
|
69 |
65 |
$395.20 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
12 |
12 |
$309.79 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
40 |
39 |
$187.42 |
| D0270 |
|
109 |
108 |
$174.38 |
| D1330 |
|
24 |
24 |
$0.00 |