| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,960 |
2,901 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
3,465 |
3,406 |
$77K |
| D0272 |
Bitewings - two radiographic images |
2,671 |
2,653 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,595 |
1,564 |
$33K |
| D1999 |
|
2,070 |
1,843 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
161 |
110 |
$12K |
| D1120 |
Prophylaxis - child |
374 |
374 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,263 |
1,186 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
323 |
323 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
89 |
51 |
$5K |
| D2335 |
|
16 |
12 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
13 |
$1K |
| D2331 |
|
17 |
12 |
$1K |
| D4355 |
|
28 |
28 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
47 |
46 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
17 |
13 |
$944.00 |