| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,510 |
2,494 |
$85K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
963 |
527 |
$55K |
| D2160 |
|
401 |
352 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
2,197 |
2,184 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,660 |
1,655 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
862 |
852 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
390 |
243 |
$26K |
| D2335 |
|
262 |
183 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,377 |
1,367 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
589 |
587 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,111 |
1,110 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
359 |
358 |
$4K |
| D1120 |
Prophylaxis - child |
110 |
110 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
28 |
28 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$0.00 |