| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
984 |
974 |
$50K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,336 |
1,686 |
$33K |
| D1120 |
Prophylaxis - child |
909 |
901 |
$32K |
| D0350 |
|
3,552 |
1,355 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
297 |
294 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
233 |
139 |
$16K |
| D1206 |
Topical application of fluoride varnish |
987 |
981 |
$12K |
| D0274 |
Bitewings - four radiographic images |
675 |
659 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
153 |
94 |
$10K |
| D9430 |
|
201 |
181 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
45 |
37 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
43 |
25 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
51 |
50 |
$2K |
| D2140 |
|
19 |
13 |
$982.80 |
| D0220 |
Intraoral - periapical first radiographic image |
78 |
78 |
$807.50 |
| D0272 |
Bitewings - two radiographic images |
61 |
61 |
$668.00 |
| D1999 |
|
408 |
366 |
$50.00 |