| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,617 |
1,608 |
$95K |
| D1120 |
Prophylaxis - child |
1,210 |
1,203 |
$50K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,402 |
1,914 |
$37K |
| D1110 |
Prophylaxis - adult |
346 |
345 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,096 |
1,094 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,834 |
1,818 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
319 |
318 |
$19K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
26 |
16 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
250 |
249 |
$11K |
| D9430 |
|
236 |
236 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
562 |
557 |
$7K |
| D0350 |
|
582 |
256 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
41 |
25 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
12 |
$1K |