| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,777 |
2,749 |
$121K |
| D0120 |
Periodic oral evaluation - established patient |
4,297 |
4,245 |
$110K |
| D1110 |
Prophylaxis - adult |
2,454 |
2,418 |
$86K |
| D0140 |
Limited oral evaluation - problem focused |
2,482 |
2,404 |
$69K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
905 |
577 |
$63K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,087 |
2,066 |
$57K |
| D0274 |
Bitewings - four radiographic images |
1,739 |
1,717 |
$54K |
| D0210 |
Intraoral - complete series of radiographic images |
802 |
787 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
780 |
764 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
1,750 |
1,708 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
191 |
135 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
97 |
67 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
15 |
12 |
$868.96 |
| D0230 |
Intraoral - periapical each additional radiographic image |
22 |
13 |
$159.12 |