| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,891 |
1,884 |
$110K |
| D1120 |
Prophylaxis - child |
1,266 |
1,259 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,559 |
2,120 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
710 |
709 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
655 |
655 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,005 |
1,996 |
$26K |
| D1110 |
Prophylaxis - adult |
285 |
285 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,107 |
1,103 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
291 |
168 |
$20K |
| D0350 |
|
406 |
358 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
130 |
85 |
$7K |
| D4341 |
|
46 |
13 |
$3K |
| D4910 |
|
25 |
25 |
$2K |
| D9430 |
|
55 |
54 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
38 |
38 |
$456.00 |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$284.00 |