| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,227 |
1,221 |
$68K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
775 |
402 |
$51K |
| D9430 |
|
1,223 |
1,062 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
603 |
600 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
743 |
735 |
$33K |
| D1110 |
Prophylaxis - adult |
348 |
346 |
$27K |
| D0350 |
|
2,543 |
1,011 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
425 |
233 |
$22K |
| D1120 |
Prophylaxis - child |
538 |
536 |
$20K |
| D2740 |
Crown - porcelain/ceramic |
29 |
16 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,845 |
1,226 |
$11K |
| D0274 |
Bitewings - four radiographic images |
229 |
229 |
$5K |
| D4910 |
|
52 |
51 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
285 |
285 |
$3K |
| D0272 |
Bitewings - two radiographic images |
16 |
16 |
$192.00 |
| D0220 |
Intraoral - periapical first radiographic image |
15 |
13 |
$180.00 |