| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,106 |
3,086 |
$171K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,771 |
1,142 |
$118K |
| D1120 |
Prophylaxis - child |
3,125 |
3,105 |
$116K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,548 |
3,395 |
$50K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
601 |
420 |
$48K |
| D0274 |
Bitewings - four radiographic images |
2,189 |
2,179 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,688 |
3,664 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
637 |
637 |
$41K |
| D1110 |
Prophylaxis - adult |
290 |
289 |
$26K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
309 |
179 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
410 |
409 |
$18K |
| D1351 |
Sealant - per tooth |
526 |
136 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
193 |
112 |
$10K |
| D0272 |
Bitewings - two radiographic images |
607 |
605 |
$7K |
| D2160 |
|
14 |
12 |
$1K |
| D9430 |
|
12 |
12 |
$384.00 |
| D0350 |
|
13 |
13 |
$0.00 |