| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,068 |
3,062 |
$157K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,148 |
1,043 |
$116K |
| D1120 |
Prophylaxis - child |
2,372 |
2,367 |
$89K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,333 |
744 |
$89K |
| D1110 |
Prophylaxis - adult |
911 |
910 |
$77K |
| D0274 |
Bitewings - four radiographic images |
2,159 |
2,154 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
868 |
867 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,508 |
3,499 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,524 |
1,796 |
$35K |
| D9430 |
|
1,058 |
1,020 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
455 |
453 |
$28K |
| D0350 |
|
2,682 |
1,006 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
266 |
170 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,076 |
1,046 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
90 |
68 |
$7K |
| D9110 |
|
35 |
34 |
$2K |
| D0272 |
Bitewings - two radiographic images |
132 |
132 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
20 |
13 |
$1K |