| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
838 |
836 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
337 |
333 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
254 |
126 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,167 |
1,995 |
$23K |
| D0274 |
Bitewings - four radiographic images |
842 |
837 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,673 |
1,565 |
$19K |
| D1110 |
Prophylaxis - adult |
542 |
541 |
$18K |
| D2740 |
Crown - porcelain/ceramic |
24 |
14 |
$14K |
| D1120 |
Prophylaxis - child |
507 |
505 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
215 |
210 |
$9K |
| D1206 |
Topical application of fluoride varnish |
524 |
521 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
65 |
29 |
$6K |
| D0330 |
Panoramic radiographic image |
336 |
332 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
47 |
15 |
$5K |
| D0272 |
Bitewings - two radiographic images |
238 |
237 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
57 |
37 |
$4K |