| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,425 |
2,405 |
$125K |
| D1110 |
Prophylaxis - adult |
1,490 |
1,481 |
$125K |
| D0210 |
Intraoral - complete series of radiographic images |
1,524 |
1,517 |
$71K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,013 |
1,013 |
$61K |
| D1120 |
Prophylaxis - child |
1,474 |
1,468 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,690 |
1,646 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,588 |
1,582 |
$17K |
| D0350 |
|
570 |
497 |
$14K |
| D0274 |
Bitewings - four radiographic images |
682 |
682 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
144 |
64 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
88 |
37 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
77 |
38 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
296 |
291 |
$3K |
| D9430 |
|
41 |
41 |
$1K |