| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,279 |
3,262 |
$176K |
| D1120 |
Prophylaxis - child |
2,603 |
2,541 |
$92K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,288 |
3,478 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,227 |
1,220 |
$75K |
| D4910 |
|
692 |
688 |
$51K |
| D0210 |
Intraoral - complete series of radiographic images |
1,086 |
1,081 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,791 |
2,755 |
$32K |
| D4341 |
|
464 |
123 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
425 |
233 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,316 |
1,308 |
$26K |
| D0350 |
|
2,399 |
585 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,756 |
1,751 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
205 |
127 |
$11K |
| D1110 |
Prophylaxis - adult |
125 |
123 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
122 |
70 |
$7K |
| D9430 |
|
195 |
182 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
64 |
27 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
198 |
191 |
$2K |
| D1351 |
Sealant - per tooth |
56 |
13 |
$1K |
| D1206 |
Topical application of fluoride varnish |
32 |
32 |
$329.00 |
| D0431 |
|
12 |
12 |
$0.00 |