| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
17,891 |
3,315 |
$71K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,122 |
1,118 |
$69K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,286 |
538 |
$68K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,005 |
528 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
981 |
977 |
$59K |
| D9430 |
|
1,488 |
1,346 |
$47K |
| D1120 |
Prophylaxis - child |
1,080 |
1,073 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,848 |
1,840 |
$36K |
| D0350 |
|
2,275 |
740 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,556 |
1,553 |
$18K |
| D1110 |
Prophylaxis - adult |
229 |
228 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,032 |
994 |
$12K |
| D1351 |
Sealant - per tooth |
204 |
70 |
$5K |
| D4910 |
|
41 |
41 |
$3K |
| D4342 |
|
50 |
14 |
$2K |
| D0272 |
Bitewings - two radiographic images |
116 |
115 |
$1K |
| D0330 |
Panoramic radiographic image |
26 |
26 |
$750.00 |