| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,102 |
1,094 |
$69K |
| D4910 |
|
750 |
742 |
$57K |
| D1110 |
Prophylaxis - adult |
579 |
576 |
$49K |
| D9430 |
|
1,405 |
1,215 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,346 |
1,987 |
$41K |
| D0350 |
|
3,648 |
1,320 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
2,379 |
2,187 |
$28K |
| D1120 |
Prophylaxis - child |
572 |
565 |
$23K |
| D1206 |
Topical application of fluoride varnish |
788 |
775 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
898 |
894 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
166 |
166 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
96 |
53 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
66 |
66 |
$3K |