| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
709 |
625 |
$24K |
| D0274 |
Bitewings - four radiographic images |
754 |
663 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
654 |
578 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
809 |
707 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
789 |
696 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,586 |
878 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,150 |
959 |
$9K |
| D1120 |
Prophylaxis - child |
489 |
426 |
$8K |
| D1351 |
Sealant - per tooth |
562 |
67 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
47 |
24 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
96 |
44 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
110 |
78 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
32 |
24 |
$1K |
| D2140 |
|
24 |
12 |
$0.00 |