| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,065 |
2,060 |
$106K |
| D0274 |
Bitewings - four radiographic images |
1,664 |
1,661 |
$55K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
478 |
292 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,335 |
1,327 |
$35K |
| D1120 |
Prophylaxis - child |
735 |
735 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
396 |
395 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
701 |
699 |
$20K |
| D0330 |
Panoramic radiographic image |
348 |
348 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
190 |
115 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
972 |
972 |
$14K |
| D2160 |
|
57 |
44 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
101 |
49 |
$4K |
| D0272 |
Bitewings - two radiographic images |
187 |
187 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
14 |
$2K |
| D1206 |
Topical application of fluoride varnish |
16 |
16 |
$462.30 |
| D0220 |
Intraoral - periapical first radiographic image |
30 |
30 |
$351.30 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$206.80 |