| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,277 |
1,270 |
$77K |
| D1110 |
Prophylaxis - adult |
765 |
762 |
$65K |
| D9430 |
|
1,861 |
1,613 |
$59K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,825 |
2,591 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
654 |
647 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,237 |
2,222 |
$29K |
| D1120 |
Prophylaxis - child |
675 |
671 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
428 |
420 |
$19K |
| D4910 |
|
271 |
267 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,342 |
1,207 |
$16K |
| D2394 |
|
185 |
78 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
174 |
66 |
$14K |
| D0274 |
Bitewings - four radiographic images |
641 |
637 |
$14K |
| D1320 |
|
853 |
846 |
$11K |
| D2335 |
|
55 |
12 |
$6K |
| D0272 |
Bitewings - two radiographic images |
76 |
76 |
$909.00 |
| D1330 |
|
35 |
35 |
$0.00 |