| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,547 |
5,547 |
$303K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,375 |
1,976 |
$214K |
| D0274 |
Bitewings - four radiographic images |
5,800 |
5,800 |
$159K |
| D0120 |
Periodic oral evaluation - established patient |
5,701 |
5,700 |
$156K |
| D2140 |
|
1,101 |
937 |
$66K |
| D2160 |
|
582 |
532 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
2,676 |
2,638 |
$35K |
| D9110 |
|
930 |
926 |
$25K |
| D2750 |
|
41 |
37 |
$23K |
| D1206 |
Topical application of fluoride varnish |
717 |
716 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,391 |
1,391 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
402 |
402 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,484 |
1,479 |
$12K |
| D1120 |
Prophylaxis - child |
209 |
209 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
79 |
58 |
$6K |
| D2331 |
|
14 |
13 |
$1K |