| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,093 |
1,088 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
1,497 |
1,496 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
930 |
329 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,558 |
1,947 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
520 |
216 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
644 |
641 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,274 |
2,269 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
454 |
452 |
$25K |
| D1120 |
Prophylaxis - child |
717 |
717 |
$24K |
| D9110 |
|
309 |
301 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,489 |
1,353 |
$17K |
| D0350 |
|
857 |
476 |
$12K |
| D0272 |
Bitewings - two radiographic images |
705 |
705 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
124 |
80 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
91 |
46 |
$6K |
| D2332 |
|
43 |
26 |
$4K |
| D2335 |
|
22 |
13 |
$3K |
| D1351 |
Sealant - per tooth |
111 |
31 |
$2K |
| D2330 |
|
26 |
12 |
$2K |