| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,902 |
2,893 |
$157K |
| D1120 |
Prophylaxis - child |
2,454 |
2,449 |
$91K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,294 |
3,455 |
$56K |
| D1110 |
Prophylaxis - adult |
600 |
598 |
$50K |
| D0274 |
Bitewings - four radiographic images |
1,412 |
1,408 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,655 |
2,652 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
267 |
267 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,288 |
1,288 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
101 |
77 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
104 |
76 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
52 |
36 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
96 |
96 |
$1K |
| D9430 |
|
12 |
12 |
$384.00 |