| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,120 |
3,102 |
$161K |
| D1120 |
Prophylaxis - child |
2,847 |
2,827 |
$102K |
| D0210 |
Intraoral - complete series of radiographic images |
1,346 |
1,333 |
$63K |
| D1110 |
Prophylaxis - adult |
679 |
674 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
507 |
507 |
$29K |
| D9430 |
|
846 |
832 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
375 |
222 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,555 |
951 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
329 |
162 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,220 |
1,208 |
$14K |
| D0274 |
Bitewings - four radiographic images |
363 |
362 |
$8K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
15 |
12 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
118 |
38 |
$7K |
| D2931 |
|
29 |
25 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
14 |
$1K |