| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,313 |
1,303 |
$71K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,553 |
2,478 |
$57K |
| D1120 |
Prophylaxis - child |
1,209 |
1,200 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
471 |
219 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
357 |
187 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,284 |
1,276 |
$15K |
| D9430 |
|
451 |
443 |
$14K |
| D0274 |
Bitewings - four radiographic images |
669 |
661 |
$14K |
| D0272 |
Bitewings - two radiographic images |
1,094 |
1,088 |
$13K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
17 |
12 |
$8K |
| D0350 |
|
355 |
162 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
38 |
38 |
$2K |
| D2954 |
|
17 |
13 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
102 |
98 |
$1K |
| D0330 |
Panoramic radiographic image |
35 |
35 |
$1K |