| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,752 |
1,577 |
$78K |
| D0210 |
Intraoral - complete series of radiographic images |
1,845 |
1,317 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,410 |
2,039 |
$71K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,081 |
604 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
2,357 |
2,147 |
$50K |
| D2160 |
|
492 |
318 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,089 |
989 |
$35K |
| D1206 |
Topical application of fluoride varnish |
1,885 |
1,673 |
$28K |
| D1120 |
Prophylaxis - child |
749 |
661 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,589 |
1,358 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,240 |
601 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
338 |
303 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
73 |
55 |
$7K |
| D2140 |
|
56 |
38 |
$4K |
| D4346 |
|
29 |
25 |
$3K |
| D4910 |
|
30 |
28 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$2K |
| D2331 |
|
15 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$367.22 |
| D1999 |
|
387 |
259 |
$70.00 |