| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,016 |
1,011 |
$52K |
| D0210 |
Intraoral - complete series of radiographic images |
804 |
801 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
448 |
447 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
358 |
162 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,491 |
770 |
$15K |
| D1120 |
Prophylaxis - child |
414 |
413 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,015 |
1,012 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
821 |
820 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
131 |
77 |
$9K |
| D1110 |
Prophylaxis - adult |
89 |
88 |
$8K |
| D0272 |
Bitewings - two radiographic images |
598 |
596 |
$7K |
| D2140 |
|
119 |
69 |
$6K |
| D2791 |
|
13 |
12 |
$6K |
| D2331 |
|
37 |
13 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
46 |
25 |
$3K |
| D2952 |
|
19 |
16 |
$2K |