| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2335 |
|
4,849 |
2,493 |
$536K |
| D1110 |
Prophylaxis - adult |
3,232 |
3,231 |
$113K |
| D0120 |
Periodic oral evaluation - established patient |
4,047 |
4,046 |
$78K |
| D2160 |
|
720 |
541 |
$48K |
| D0210 |
Intraoral - complete series of radiographic images |
1,262 |
1,260 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,155 |
3,148 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,656 |
1,656 |
$29K |
| D1120 |
Prophylaxis - child |
950 |
950 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,473 |
2,469 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,757 |
1,757 |
$18K |
| D1351 |
Sealant - per tooth |
257 |
80 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
123 |
72 |
$8K |
| D0272 |
Bitewings - two radiographic images |
389 |
389 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
171 |
171 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
16 |
$951.30 |
| D2140 |
|
15 |
15 |
$613.80 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
15 |
13 |
$450.60 |