| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,881 |
2,873 |
$157K |
| D1120 |
Prophylaxis - child |
2,307 |
2,299 |
$85K |
| D1110 |
Prophylaxis - adult |
798 |
795 |
$69K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,281 |
2,803 |
$66K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,188 |
3,177 |
$38K |
| D0272 |
Bitewings - two radiographic images |
2,286 |
2,280 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
238 |
117 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
273 |
272 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
147 |
147 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
97 |
44 |
$6K |
| D1351 |
Sealant - per tooth |
192 |
52 |
$4K |
| D0274 |
Bitewings - four radiographic images |
90 |
89 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
28 |
28 |
$304.00 |
| D0350 |
|
43 |
30 |
$291.60 |