| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,300 |
4,281 |
$236K |
| D1120 |
Prophylaxis - child |
4,596 |
4,577 |
$175K |
| D0230 |
Intraoral - periapical each additional radiographic image |
27,365 |
5,095 |
$112K |
| D1351 |
Sealant - per tooth |
3,920 |
1,105 |
$106K |
| D0272 |
Bitewings - two radiographic images |
4,261 |
4,238 |
$51K |
| D0210 |
Intraoral - complete series of radiographic images |
876 |
872 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
518 |
517 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
425 |
151 |
$29K |
| D9430 |
|
390 |
382 |
$12K |
| D1110 |
Prophylaxis - adult |
108 |
108 |
$10K |
| D9993 |
|
160 |
160 |
$10K |
| D1310 |
|
185 |
185 |
$8K |
| D4341 |
|
98 |
25 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
94 |
41 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
110 |
40 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
207 |
207 |
$4K |
| D2140 |
|
31 |
13 |
$1K |
| D0601 |
|
12 |
12 |
$180.00 |