| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,460 |
2,456 |
$50K |
| D1110 |
Prophylaxis - adult |
1,248 |
1,243 |
$33K |
| D1120 |
Prophylaxis - child |
1,461 |
1,460 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
851 |
362 |
$29K |
| D0272 |
Bitewings - two radiographic images |
2,455 |
2,451 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,547 |
1,546 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,715 |
2,705 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
2,940 |
2,907 |
$12K |
| D0191 |
|
161 |
155 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
126 |
126 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
27 |
14 |
$1K |