| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,362 |
2,342 |
$131K |
| D1120 |
Prophylaxis - child |
2,184 |
2,169 |
$82K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,172 |
2,993 |
$65K |
| D0274 |
Bitewings - four radiographic images |
2,111 |
2,091 |
$44K |
| D1110 |
Prophylaxis - adult |
377 |
370 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,470 |
2,453 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
386 |
383 |
$23K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
215 |
131 |
$14K |
| D2140 |
|
57 |
37 |
$3K |
| D0350 |
|
342 |
156 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
189 |
186 |
$2K |
| D0272 |
Bitewings - two radiographic images |
139 |
139 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
12 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$928.20 |