| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,293 |
3,202 |
$175K |
| D1110 |
Prophylaxis - adult |
1,448 |
1,439 |
$120K |
| D1120 |
Prophylaxis - child |
3,102 |
3,090 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,364 |
1,360 |
$84K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,140 |
595 |
$75K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,177 |
454 |
$63K |
| D0272 |
Bitewings - two radiographic images |
3,817 |
3,802 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,104 |
3,089 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,145 |
4,121 |
$31K |
| D1310 |
|
80 |
80 |
$3K |
| D0601 |
|
54 |
54 |
$780.00 |
| D9993 |
|
13 |
13 |
$780.00 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$144.00 |