| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,531 |
3,499 |
$152K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,042 |
2,029 |
$116K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,555 |
961 |
$98K |
| D1120 |
Prophylaxis - child |
3,008 |
2,988 |
$88K |
| D1110 |
Prophylaxis - adult |
1,187 |
1,172 |
$82K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,675 |
5,990 |
$75K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,061 |
639 |
$54K |
| D4341 |
|
768 |
234 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,093 |
4,065 |
$45K |
| D0274 |
Bitewings - four radiographic images |
2,099 |
2,091 |
$39K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
63 |
54 |
$30K |
| D0272 |
Bitewings - two radiographic images |
2,575 |
2,563 |
$25K |
| D4910 |
|
313 |
310 |
$24K |
| D9430 |
|
461 |
446 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
718 |
690 |
$6K |
| D1351 |
Sealant - per tooth |
278 |
57 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
126 |
124 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
18 |
13 |
$2K |