| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,733 |
2,704 |
$125K |
| D0120 |
Periodic oral evaluation - established patient |
3,324 |
3,298 |
$90K |
| D0274 |
Bitewings - four radiographic images |
1,667 |
1,649 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
1,989 |
1,934 |
$24K |
| D1120 |
Prophylaxis - child |
534 |
530 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
911 |
907 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
460 |
448 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
255 |
125 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,465 |
1,052 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
290 |
277 |
$10K |
| D2140 |
|
129 |
66 |
$5K |
| D1206 |
Topical application of fluoride varnish |
282 |
278 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
81 |
79 |
$4K |
| D1999 |
|
467 |
378 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
29 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
38 |
38 |
$590.60 |
| D0270 |
|
14 |
14 |
$148.00 |
| D0602 |
|
20 |
14 |
$100.00 |
| D1330 |
|
49 |
45 |
$10.00 |
| D1310 |
|
18 |
14 |
$0.00 |