| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,158 |
6,155 |
$214K |
| D0120 |
Periodic oral evaluation - established patient |
7,879 |
7,875 |
$142K |
| D0274 |
Bitewings - four radiographic images |
6,741 |
6,739 |
$116K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,393 |
997 |
$71K |
| D2752 |
|
191 |
173 |
$71K |
| D2954 |
|
415 |
396 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
4,147 |
4,117 |
$30K |
| D2791 |
|
52 |
51 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,324 |
1,323 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
183 |
166 |
$11K |
| D3320 |
|
54 |
53 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,630 |
1,629 |
$9K |
| D1120 |
Prophylaxis - child |
264 |
264 |
$7K |
| D9310 |
|
222 |
222 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
113 |
88 |
$4K |
| D9110 |
|
151 |
151 |
$2K |
| D0272 |
Bitewings - two radiographic images |
215 |
215 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
48 |
26 |
$2K |
| D2331 |
|
23 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
51 |
51 |
$557.16 |