| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,522 |
7,520 |
$268K |
| D0120 |
Periodic oral evaluation - established patient |
9,217 |
9,214 |
$174K |
| D0274 |
Bitewings - four radiographic images |
5,081 |
5,081 |
$95K |
| D0220 |
Intraoral - periapical first radiographic image |
8,810 |
8,706 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,073 |
708 |
$56K |
| D1120 |
Prophylaxis - child |
1,496 |
1,496 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,300 |
5,081 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,017 |
3,015 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
517 |
435 |
$32K |
| D9110 |
|
1,889 |
1,874 |
$27K |
| D0272 |
Bitewings - two radiographic images |
373 |
373 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
58 |
51 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
231 |
230 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
60 |
45 |
$2K |
| D2160 |
|
25 |
25 |
$1K |
| D0270 |
|
24 |
24 |
$207.46 |
| D1999 |
|
19 |
18 |
$0.00 |