| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,456 |
1,447 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
2,089 |
2,071 |
$114K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,028 |
499 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,076 |
1,065 |
$65K |
| D1120 |
Prophylaxis - child |
1,462 |
1,448 |
$56K |
| D0210 |
Intraoral - complete series of radiographic images |
1,013 |
1,005 |
$45K |
| D4910 |
|
562 |
558 |
$43K |
| D0350 |
|
3,419 |
1,333 |
$31K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
449 |
210 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,766 |
1,749 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,823 |
1,808 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,852 |
2,387 |
$19K |
| D4341 |
|
196 |
52 |
$14K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
19 |
13 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
153 |
98 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
75 |
43 |
$6K |
| D9430 |
|
170 |
163 |
$5K |
| D2160 |
|
21 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
80 |
80 |
$824.00 |
| D1999 |
|
25 |
23 |
$0.00 |