| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
937 |
931 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
781 |
775 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
648 |
337 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
710 |
705 |
$34K |
| D4910 |
|
351 |
348 |
$30K |
| D1120 |
Prophylaxis - child |
561 |
558 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,306 |
1,299 |
$25K |
| D1110 |
Prophylaxis - adult |
201 |
197 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
283 |
131 |
$15K |
| D2740 |
Crown - porcelain/ceramic |
15 |
13 |
$7K |
| D9430 |
|
175 |
157 |
$6K |
| D0274 |
Bitewings - four radiographic images |
254 |
249 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
818 |
451 |
$3K |
| D0350 |
|
276 |
98 |
$3K |
| D1999 |
|
92 |
89 |
$640.00 |
| D0220 |
Intraoral - periapical first radiographic image |
42 |
42 |
$480.80 |