| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,485 |
1,469 |
$88K |
| D1110 |
Prophylaxis - adult |
483 |
483 |
$43K |
| D1120 |
Prophylaxis - child |
1,019 |
1,006 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,762 |
2,374 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
488 |
488 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,198 |
1,186 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
351 |
284 |
$23K |
| D2740 |
Crown - porcelain/ceramic |
44 |
39 |
$20K |
| D9430 |
|
190 |
186 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
92 |
64 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
418 |
412 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
79 |
79 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
47 |
25 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
25 |
$2K |
| D0272 |
Bitewings - two radiographic images |
42 |
42 |
$468.00 |