| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
970 |
962 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,204 |
1,126 |
$22K |
| D1120 |
Prophylaxis - child |
557 |
555 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
266 |
263 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,169 |
1,162 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,233 |
1,230 |
$13K |
| D0272 |
Bitewings - two radiographic images |
978 |
971 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
174 |
172 |
$8K |
| D1110 |
Prophylaxis - adult |
79 |
78 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
85 |
24 |
$4K |
| D2140 |
|
70 |
28 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
24 |
14 |
$2K |