| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,550 |
4,536 |
$231K |
| D0230 |
Intraoral - periapical each additional radiographic image |
38,616 |
7,367 |
$156K |
| D1120 |
Prophylaxis - child |
4,118 |
4,115 |
$150K |
| D1110 |
Prophylaxis - adult |
1,176 |
1,175 |
$91K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,133 |
593 |
$71K |
| D9430 |
|
2,014 |
2,005 |
$63K |
| D0272 |
Bitewings - two radiographic images |
5,091 |
5,086 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
857 |
857 |
$51K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
603 |
325 |
$39K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
70 |
55 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
660 |
350 |
$33K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
64 |
61 |
$29K |
| D1351 |
Sealant - per tooth |
1,176 |
359 |
$25K |
| D0350 |
|
2,383 |
997 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
905 |
901 |
$10K |
| D2140 |
|
191 |
108 |
$10K |
| D0274 |
Bitewings - four radiographic images |
455 |
455 |
$10K |
| D2330 |
|
51 |
25 |
$4K |
| D0270 |
|
259 |
256 |
$1K |