| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,891 |
1,880 |
$105K |
| D1120 |
Prophylaxis - child |
1,443 |
1,436 |
$53K |
| D1110 |
Prophylaxis - adult |
485 |
485 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,631 |
2,691 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
404 |
402 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,985 |
1,775 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,615 |
1,609 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,113 |
1,107 |
$13K |
| D0350 |
|
1,147 |
651 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
137 |
86 |
$9K |
| D9430 |
|
241 |
235 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
157 |
157 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
30 |
14 |
$2K |