| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,594 |
2,572 |
$135K |
| D1110 |
Prophylaxis - adult |
1,371 |
1,364 |
$114K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,651 |
2,845 |
$79K |
| D9430 |
|
2,115 |
1,848 |
$67K |
| D1120 |
Prophylaxis - child |
1,457 |
1,446 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
925 |
437 |
$50K |
| D0210 |
Intraoral - complete series of radiographic images |
998 |
992 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
706 |
704 |
$43K |
| D0350 |
|
2,816 |
1,283 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,325 |
2,307 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
383 |
245 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,720 |
1,667 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,567 |
1,550 |
$18K |
| D4910 |
|
226 |
225 |
$17K |
| D2740 |
Crown - porcelain/ceramic |
31 |
24 |
$14K |
| D2330 |
|
19 |
14 |
$1K |
| D1206 |
Topical application of fluoride varnish |
36 |
36 |
$348.00 |
| D1310 |
|
21 |
21 |
$0.00 |
| D0602 |
|
18 |
18 |
$0.00 |