| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,436 |
1,385 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,051 |
2,021 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
1,253 |
1,212 |
$26K |
| D1120 |
Prophylaxis - child |
1,203 |
1,163 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
375 |
202 |
$21K |
| D1351 |
Sealant - per tooth |
775 |
179 |
$13K |
| D0274 |
Bitewings - four radiographic images |
992 |
957 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
116 |
70 |
$7K |
| D1999 |
|
502 |
465 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
145 |
139 |
$5K |
| D0272 |
Bitewings - two radiographic images |
348 |
337 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
71 |
31 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
183 |
181 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
29 |
29 |
$545.78 |
| D1206 |
Topical application of fluoride varnish |
22 |
22 |
$281.89 |
| D0230 |
Intraoral - periapical each additional radiographic image |
15 |
13 |
$34.83 |