| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,052 |
1,045 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
990 |
980 |
$49K |
| D9110 |
|
374 |
352 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,211 |
1,205 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,380 |
1,371 |
$18K |
| D2330 |
|
183 |
63 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
153 |
60 |
$10K |
| D0272 |
Bitewings - two radiographic images |
782 |
781 |
$9K |
| D7510 |
|
78 |
78 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
93 |
43 |
$5K |
| D4341 |
|
38 |
13 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$350.00 |
| D0350 |
|
13 |
12 |
$268.80 |