| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,675 |
1,670 |
$102K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,354 |
678 |
$91K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,276 |
1,273 |
$79K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
981 |
594 |
$78K |
| D1120 |
Prophylaxis - child |
1,954 |
1,948 |
$77K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,317 |
2,202 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
696 |
693 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,459 |
2,450 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,721 |
1,717 |
$20K |
| D1110 |
Prophylaxis - adult |
218 |
218 |
$19K |
| D9430 |
|
562 |
525 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
96 |
49 |
$6K |
| D2394 |
|
44 |
39 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
13 |
$982.80 |