| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,210 |
1,204 |
$85K |
| D0350 |
|
8,342 |
2,422 |
$79K |
| D1120 |
Prophylaxis - child |
1,547 |
1,539 |
$68K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
845 |
495 |
$56K |
| D2740 |
Crown - porcelain/ceramic |
89 |
64 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
588 |
586 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,279 |
1,273 |
$20K |
| D0274 |
Bitewings - four radiographic images |
762 |
758 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,711 |
1,637 |
$15K |
| D9430 |
|
429 |
401 |
$13K |
| D1110 |
Prophylaxis - adult |
143 |
143 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
229 |
151 |
$12K |
| D1206 |
Topical application of fluoride varnish |
525 |
522 |
$8K |
| D2954 |
|
74 |
58 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
579 |
560 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
142 |
140 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
87 |
40 |
$5K |
| D0272 |
Bitewings - two radiographic images |
352 |
351 |
$4K |
| D1310 |
|
73 |
70 |
$3K |
| D0603 |
|
114 |
112 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
17 |
17 |
$1K |
| D9110 |
|
14 |
12 |
$882.00 |
| D9993 |
|
15 |
13 |
$715.00 |