| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,094 |
2,052 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
2,765 |
2,715 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,156 |
3,095 |
$62K |
| D1120 |
Prophylaxis - child |
1,316 |
1,256 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,571 |
1,538 |
$40K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
254 |
127 |
$18K |
| D0330 |
Panoramic radiographic image |
409 |
405 |
$15K |
| D0272 |
Bitewings - two radiographic images |
725 |
704 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
403 |
395 |
$11K |
| D2140 |
|
113 |
70 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
81 |
58 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
80 |
53 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
102 |
101 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
42 |
41 |
$931.60 |