| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,550 |
2,547 |
$93K |
| D0120 |
Periodic oral evaluation - established patient |
2,905 |
2,902 |
$58K |
| D0274 |
Bitewings - four radiographic images |
2,309 |
2,308 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
3,079 |
3,041 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,470 |
2,465 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
194 |
138 |
$11K |
| D2160 |
|
109 |
76 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
146 |
115 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
69 |
39 |
$5K |
| D2332 |
|
59 |
36 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
65 |
65 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
53 |
52 |
$535.68 |
| D1208 |
Topical application of fluoride, excluding varnish |
28 |
28 |
$308.50 |
| D9110 |
|
12 |
12 |
$197.02 |