| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,566 |
3,550 |
$200K |
| D1120 |
Prophylaxis - child |
3,560 |
3,541 |
$138K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,615 |
1,133 |
$130K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
856 |
579 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,538 |
3,515 |
$45K |
| D0210 |
Intraoral - complete series of radiographic images |
858 |
844 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,529 |
2,445 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
474 |
468 |
$28K |
| D0350 |
|
3,221 |
1,657 |
$26K |
| D1110 |
Prophylaxis - adult |
322 |
317 |
$25K |
| D9430 |
|
780 |
750 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,026 |
2,258 |
$20K |
| D0274 |
Bitewings - four radiographic images |
457 |
456 |
$9K |
| D0272 |
Bitewings - two radiographic images |
805 |
801 |
$9K |
| D2140 |
|
178 |
80 |
$8K |
| D1310 |
|
183 |
182 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
122 |
80 |
$8K |
| D9993 |
|
113 |
112 |
$6K |
| D1351 |
Sealant - per tooth |
181 |
53 |
$6K |