| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,043 |
2,040 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
2,339 |
2,333 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
991 |
990 |
$40K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
530 |
271 |
$27K |
| D2160 |
|
371 |
195 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
177 |
98 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
621 |
620 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
731 |
731 |
$6K |
| D0272 |
Bitewings - two radiographic images |
448 |
448 |
$5K |
| D0274 |
Bitewings - four radiographic images |
211 |
211 |
$4K |
| D4341 |
|
85 |
25 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
140 |
140 |
$3K |
| D1120 |
Prophylaxis - child |
60 |
60 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
48 |
24 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
144 |
144 |
$2K |
| D1999 |
|
18 |
13 |
$0.00 |