| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
1,148 |
1,046 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
948 |
932 |
$29K |
| D1999 |
|
243 |
214 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,061 |
1,042 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,772 |
1,662 |
$15K |
| D1110 |
Prophylaxis - adult |
321 |
308 |
$12K |
| D2740 |
Crown - porcelain/ceramic |
21 |
12 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
158 |
145 |
$8K |
| D0274 |
Bitewings - four radiographic images |
449 |
423 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
128 |
62 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
56 |
30 |
$7K |
| D1120 |
Prophylaxis - child |
822 |
811 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
154 |
138 |
$3K |
| D0330 |
Panoramic radiographic image |
50 |
44 |
$312.94 |
| D0272 |
Bitewings - two radiographic images |
117 |
109 |
$128.58 |