| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,024 |
2,019 |
$107K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,545 |
1,543 |
$89K |
| D0210 |
Intraoral - complete series of radiographic images |
1,492 |
1,489 |
$66K |
| D1110 |
Prophylaxis - adult |
865 |
864 |
$64K |
| D1120 |
Prophylaxis - child |
1,600 |
1,592 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,979 |
2,963 |
$33K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
69 |
68 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
415 |
226 |
$27K |
| D0274 |
Bitewings - four radiographic images |
1,289 |
1,284 |
$24K |
| D9430 |
|
617 |
581 |
$20K |
| D2740 |
Crown - porcelain/ceramic |
39 |
34 |
$19K |
| D3320 |
|
14 |
13 |
$5K |
| D2954 |
|
37 |
30 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
130 |
130 |
$2K |
| D0272 |
Bitewings - two radiographic images |
37 |
37 |
$432.00 |
| D1320 |
|
19 |
19 |
$332.50 |