| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,382 |
2,235 |
$110K |
| D0120 |
Periodic oral evaluation - established patient |
3,188 |
3,081 |
$88K |
| D0210 |
Intraoral - complete series of radiographic images |
1,385 |
1,303 |
$82K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
711 |
401 |
$66K |
| D1120 |
Prophylaxis - child |
1,372 |
1,356 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,700 |
1,676 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
505 |
427 |
$21K |
| D2950 |
|
139 |
117 |
$18K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
162 |
92 |
$13K |
| D2931 |
|
37 |
25 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
575 |
535 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
526 |
504 |
$7K |
| D0272 |
Bitewings - two radiographic images |
319 |
319 |
$7K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
15 |
13 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
91 |
59 |
$7K |
| D1351 |
Sealant - per tooth |
208 |
70 |
$6K |
| D2160 |
|
51 |
30 |
$5K |
| D1206 |
Topical application of fluoride varnish |
152 |
151 |
$4K |
| D2140 |
|
33 |
24 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$627.55 |