| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,287 |
4,252 |
$125K |
| D0120 |
Periodic oral evaluation - established patient |
4,209 |
4,176 |
$70K |
| D1206 |
Topical application of fluoride varnish |
4,082 |
4,046 |
$59K |
| D0274 |
Bitewings - four radiographic images |
2,986 |
2,965 |
$58K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
953 |
648 |
$42K |
| D0330 |
Panoramic radiographic image |
788 |
780 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
1,814 |
1,787 |
$29K |
| D1120 |
Prophylaxis - child |
1,457 |
1,447 |
$25K |
| D2140 |
|
724 |
453 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,603 |
1,438 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
402 |
300 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
258 |
194 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
317 |
307 |
$4K |
| D2331 |
|
73 |
50 |
$2K |
| D0272 |
Bitewings - two radiographic images |
155 |
154 |
$2K |
| D2330 |
|
39 |
26 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
106 |
76 |
$632.82 |
| D1999 |
|
133 |
112 |
$0.00 |