| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,284 |
2,272 |
$122K |
| D1120 |
Prophylaxis - child |
1,918 |
1,915 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,007 |
1,005 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,224 |
3,314 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
727 |
338 |
$48K |
| D9430 |
|
1,382 |
1,176 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
756 |
755 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,712 |
2,701 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,442 |
1,441 |
$31K |
| D1110 |
Prophylaxis - adult |
280 |
279 |
$23K |
| D0350 |
|
2,032 |
819 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
241 |
106 |
$13K |
| D0272 |
Bitewings - two radiographic images |
464 |
460 |
$5K |
| D1351 |
Sealant - per tooth |
114 |
26 |
$3K |
| D0270 |
|
622 |
537 |
$3K |
| D4910 |
|
31 |
31 |
$2K |
| D0330 |
Panoramic radiographic image |
74 |
74 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
82 |
81 |
$886.00 |
| D1999 |
|
69 |
68 |
$0.00 |