| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,838 |
3,815 |
$222K |
| D1110 |
Prophylaxis - adult |
2,262 |
2,245 |
$193K |
| D1120 |
Prophylaxis - child |
1,958 |
1,952 |
$71K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,138 |
3,252 |
$59K |
| D0274 |
Bitewings - four radiographic images |
2,484 |
2,472 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,961 |
3,940 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
444 |
354 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
307 |
305 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,008 |
972 |
$12K |
| D9430 |
|
335 |
324 |
$11K |
| D2740 |
Crown - porcelain/ceramic |
19 |
14 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
34 |
25 |
$3K |
| D2330 |
|
17 |
12 |
$1K |
| D4910 |
|
13 |
13 |
$1K |
| D9110 |
|
12 |
12 |
$756.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$130.00 |