| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
315 |
303 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
461 |
450 |
$12K |
| D1120 |
Prophylaxis - child |
296 |
294 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
116 |
65 |
$9K |
| D1206 |
Topical application of fluoride varnish |
275 |
273 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
387 |
373 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
505 |
315 |
$4K |
| D0274 |
Bitewings - four radiographic images |
111 |
108 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
90 |
87 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
14 |
$2K |
| D2160 |
|
17 |
12 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
28 |
26 |
$1K |
| D2140 |
|
22 |
14 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
33 |
30 |
$1K |