| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,806 |
3,801 |
$196K |
| D1110 |
Prophylaxis - adult |
1,454 |
1,453 |
$122K |
| D1120 |
Prophylaxis - child |
2,738 |
2,734 |
$97K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,919 |
4,321 |
$80K |
| D0210 |
Intraoral - complete series of radiographic images |
1,369 |
1,368 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,028 |
1,027 |
$62K |
| D0274 |
Bitewings - four radiographic images |
2,515 |
2,513 |
$53K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
703 |
419 |
$47K |
| D1206 |
Topical application of fluoride varnish |
2,437 |
2,433 |
$32K |
| D9430 |
|
813 |
806 |
$26K |
| D2160 |
|
178 |
122 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,173 |
1,155 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,041 |
1,039 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
127 |
92 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
67 |
56 |
$5K |
| D2330 |
|
50 |
26 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
13 |
$1K |
| D0272 |
Bitewings - two radiographic images |
117 |
117 |
$1K |