| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,037 |
2,023 |
$101K |
| D1120 |
Prophylaxis - child |
1,852 |
1,839 |
$70K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,641 |
2,754 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
551 |
296 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,235 |
2,225 |
$26K |
| D0272 |
Bitewings - two radiographic images |
2,118 |
2,105 |
$25K |
| D1110 |
Prophylaxis - adult |
243 |
241 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
283 |
156 |
$15K |
| D1351 |
Sealant - per tooth |
410 |
106 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
145 |
143 |
$8K |
| D4341 |
|
98 |
25 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
449 |
435 |
$5K |
| D9430 |
|
166 |
163 |
$5K |
| D4910 |
|
53 |
53 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
25 |
$1K |
| D1206 |
Topical application of fluoride varnish |
55 |
55 |
$885.00 |
| D0270 |
|
15 |
13 |
$60.00 |
| D1330 |
|
23 |
22 |
$0.00 |