| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2160 |
|
2,801 |
950 |
$171K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,111 |
901 |
$115K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,681 |
3,590 |
$90K |
| D1120 |
Prophylaxis - child |
1,934 |
1,899 |
$88K |
| D1110 |
Prophylaxis - adult |
1,382 |
1,337 |
$58K |
| D1206 |
Topical application of fluoride varnish |
2,829 |
2,773 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
502 |
207 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
374 |
205 |
$23K |
| D2332 |
|
348 |
117 |
$21K |
| D0272 |
Bitewings - two radiographic images |
806 |
796 |
$12K |
| D2140 |
|
27 |
19 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
13 |
$755.82 |
| D9110 |
|
25 |
24 |
$532.16 |
| D0220 |
Intraoral - periapical first radiographic image |
38 |
37 |
$336.56 |