| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
573 |
540 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,770 |
1,959 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
889 |
853 |
$21K |
| D9430 |
|
491 |
444 |
$11K |
| D0272 |
Bitewings - two radiographic images |
1,561 |
1,504 |
$11K |
| D1120 |
Prophylaxis - child |
364 |
351 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,422 |
1,279 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
109 |
108 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
367 |
354 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
25 |
17 |
$1K |
| D1351 |
Sealant - per tooth |
56 |
12 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19 |
12 |
$999.80 |
| D1999 |
|
63 |
36 |
$150.00 |
| D1330 |
|
126 |
123 |
$0.00 |