| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,679 |
1,678 |
$93K |
| D1110 |
Prophylaxis - adult |
1,055 |
1,055 |
$92K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,998 |
2,618 |
$54K |
| D1120 |
Prophylaxis - child |
828 |
824 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,335 |
2,331 |
$29K |
| D2140 |
|
470 |
179 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,960 |
1,957 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
329 |
328 |
$21K |
| D0350 |
|
1,167 |
470 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
608 |
561 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
128 |
128 |
$6K |
| D4341 |
|
62 |
24 |
$4K |
| D9430 |
|
94 |
91 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
28 |
12 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
18 |
12 |
$1K |