| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,433 |
3,399 |
$205K |
| D1120 |
Prophylaxis - child |
3,033 |
3,001 |
$122K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,479 |
1,006 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,084 |
1,083 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,865 |
3,819 |
$47K |
| D0274 |
Bitewings - four radiographic images |
2,037 |
2,017 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,277 |
3,667 |
$41K |
| D4910 |
|
348 |
348 |
$27K |
| D1110 |
Prophylaxis - adult |
267 |
259 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
326 |
326 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,278 |
1,266 |
$15K |
| D4341 |
|
200 |
57 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
150 |
120 |
$12K |
| D1310 |
|
90 |
90 |
$4K |
| D9430 |
|
123 |
121 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
54 |
39 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
268 |
265 |
$3K |
| D9993 |
|
90 |
90 |
$2K |
| D0330 |
Panoramic radiographic image |
68 |
68 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
25 |
$2K |
| D0350 |
|
57 |
29 |
$537.60 |
| D0601 |
|
12 |
12 |
$180.00 |