| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,539 |
1,529 |
$84K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,957 |
1,738 |
$41K |
| D1120 |
Prophylaxis - child |
1,053 |
1,037 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
546 |
372 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,304 |
1,294 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
264 |
256 |
$16K |
| D1110 |
Prophylaxis - adult |
190 |
190 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
141 |
95 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
140 |
137 |
$7K |
| D0350 |
|
621 |
364 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
19 |
15 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
53 |
52 |
$526.00 |