| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,488 |
3,487 |
$116K |
| D0210 |
Intraoral - complete series of radiographic images |
4,253 |
4,233 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
2,687 |
2,687 |
$53K |
| D0274 |
Bitewings - four radiographic images |
2,758 |
2,758 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,989 |
2,989 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,172 |
2,172 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
334 |
297 |
$34K |
| D1120 |
Prophylaxis - child |
989 |
989 |
$29K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
257 |
219 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,827 |
1,827 |
$21K |
| D2332 |
|
140 |
130 |
$13K |
| D2160 |
|
75 |
66 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
226 |
224 |
$2K |
| D2331 |
|
15 |
14 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
13 |
12 |
$868.72 |
| D0140 |
Limited oral evaluation - problem focused |
73 |
72 |
$511.22 |