| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,869 |
3,868 |
$129K |
| D0274 |
Bitewings - four radiographic images |
4,168 |
4,167 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
2,773 |
2,770 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
5,458 |
5,433 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,263 |
2,262 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,212 |
4,202 |
$21K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
362 |
229 |
$19K |
| D1120 |
Prophylaxis - child |
365 |
364 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
679 |
675 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
334 |
333 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
37 |
24 |
$2K |
| D0270 |
|
29 |
29 |
$270.48 |