| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
982 |
974 |
$68K |
| D1120 |
Prophylaxis - child |
958 |
952 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
523 |
523 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,524 |
1,516 |
$21K |
| D1110 |
Prophylaxis - adult |
215 |
215 |
$19K |
| D0274 |
Bitewings - four radiographic images |
884 |
878 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,948 |
1,424 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
108 |
67 |
$7K |
| D9430 |
|
130 |
128 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
65 |
41 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
41 |
41 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
145 |
141 |
$2K |
| D4910 |
|
12 |
12 |
$924.00 |
| D0272 |
Bitewings - two radiographic images |
15 |
15 |
$177.00 |