| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,563 |
1,558 |
$87K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
953 |
483 |
$63K |
| D1120 |
Prophylaxis - child |
1,142 |
1,141 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
488 |
488 |
$31K |
| D1110 |
Prophylaxis - adult |
344 |
344 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,963 |
1,958 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,821 |
1,908 |
$23K |
| D9430 |
|
714 |
651 |
$23K |
| D0274 |
Bitewings - four radiographic images |
1,020 |
1,018 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
193 |
193 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
75 |
52 |
$4K |
| D0350 |
|
305 |
166 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
229 |
225 |
$3K |
| D0272 |
Bitewings - two radiographic images |
113 |
113 |
$1K |