| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,893 |
7,879 |
$435K |
| D1110 |
Prophylaxis - adult |
4,388 |
4,378 |
$375K |
| D1120 |
Prophylaxis - child |
4,916 |
4,913 |
$179K |
| D1206 |
Topical application of fluoride varnish |
9,770 |
9,753 |
$131K |
| D0210 |
Intraoral - complete series of radiographic images |
2,050 |
2,047 |
$95K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23,721 |
5,644 |
$94K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,522 |
1,520 |
$94K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,384 |
870 |
$92K |
| D0274 |
Bitewings - four radiographic images |
3,893 |
3,882 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,005 |
624 |
$55K |
| D0350 |
|
3,940 |
1,818 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
1,794 |
1,776 |
$21K |
| D4341 |
|
162 |
59 |
$10K |
| D9430 |
|
322 |
322 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
93 |
63 |
$5K |
| D0250 |
|
25 |
25 |
$550.00 |
| D1330 |
|
82 |
82 |
$0.00 |
| D1310 |
|
81 |
81 |
$0.00 |