| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,475 |
2,472 |
$103K |
| D0120 |
Periodic oral evaluation - established patient |
1,891 |
1,889 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,698 |
1,698 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,298 |
2,288 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,024 |
1,023 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,127 |
2,123 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
373 |
370 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
142 |
96 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
604 |
604 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
88 |
46 |
$3K |
| D1120 |
Prophylaxis - child |
83 |
83 |
$3K |
| D2140 |
|
67 |
56 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$130.91 |
| D1999 |
|
22 |
21 |
$0.00 |