| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,039 |
1,039 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
764 |
764 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,627 |
1,844 |
$37K |
| D1120 |
Prophylaxis - child |
752 |
752 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,141 |
1,140 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,666 |
1,665 |
$22K |
| D9430 |
|
637 |
594 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
283 |
135 |
$19K |
| D1110 |
Prophylaxis - adult |
177 |
177 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
325 |
325 |
$15K |
| D2740 |
Crown - porcelain/ceramic |
20 |
14 |
$10K |
| D0350 |
|
721 |
278 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
21 |
12 |
$2K |
| D9910 |
|
28 |
28 |
$2K |
| D0330 |
Panoramic radiographic image |
43 |
43 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
25 |
25 |
$300.00 |
| D1999 |
|
25 |
24 |
$0.00 |