| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,272 |
1,272 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
567 |
455 |
$22K |
| D1110 |
Prophylaxis - adult |
935 |
935 |
$19K |
| D1120 |
Prophylaxis - child |
547 |
547 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
400 |
390 |
$8K |
| D0274 |
Bitewings - four radiographic images |
876 |
876 |
$8K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
27 |
27 |
$7K |
| D0190 |
|
634 |
634 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
169 |
140 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
972 |
971 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
1,292 |
1,287 |
$5K |
| D1206 |
Topical application of fluoride varnish |
545 |
545 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
493 |
493 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
134 |
134 |
$3K |
| D0330 |
Panoramic radiographic image |
124 |
124 |
$2K |
| D0272 |
Bitewings - two radiographic images |
365 |
364 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
48 |
39 |
$2K |
| D2950 |
|
15 |
15 |
$675.00 |
| D0270 |
|
224 |
222 |
$663.00 |
| D1999 |
|
101 |
88 |
$0.00 |