| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
13,663 |
2,381 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
750 |
743 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
579 |
578 |
$33K |
| D1120 |
Prophylaxis - child |
710 |
702 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,225 |
1,216 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
142 |
81 |
$11K |
| D0272 |
Bitewings - two radiographic images |
787 |
786 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
102 |
102 |
$4K |
| D1351 |
Sealant - per tooth |
67 |
13 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
34 |
27 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
26 |
14 |
$2K |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
84 |
84 |
$619.65 |
| D0270 |
|
92 |
92 |
$455.00 |
| D0350 |
|
32 |
20 |
$249.60 |