| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,979 |
1,976 |
$80K |
| D0274 |
Bitewings - four radiographic images |
3,139 |
3,136 |
$65K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
770 |
635 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
2,329 |
2,328 |
$48K |
| D1120 |
Prophylaxis - child |
1,466 |
1,462 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
3,693 |
3,646 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,438 |
3,426 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,092 |
1,091 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
312 |
258 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,526 |
1,526 |
$16K |
| D1320 |
|
1,782 |
1,778 |
$13K |
| D1206 |
Topical application of fluoride varnish |
366 |
366 |
$8K |
| D9110 |
|
332 |
328 |
$6K |
| D1351 |
Sealant - per tooth |
88 |
80 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
109 |
91 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
33 |
29 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
14 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
132 |
130 |
$1K |
| D9995 |
|
22 |
22 |
$0.00 |