| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,231 |
3,212 |
$197K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,528 |
1,497 |
$167K |
| D1120 |
Prophylaxis - child |
3,762 |
3,736 |
$149K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,112 |
1,248 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,517 |
1,508 |
$98K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,462 |
4,448 |
$94K |
| D9430 |
|
2,297 |
1,992 |
$73K |
| D0274 |
Bitewings - four radiographic images |
2,867 |
2,851 |
$60K |
| D0350 |
|
5,932 |
2,448 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,099 |
4,064 |
$45K |
| D1351 |
Sealant - per tooth |
1,702 |
658 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
793 |
785 |
$37K |
| D1110 |
Prophylaxis - adult |
330 |
329 |
$29K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
145 |
115 |
$12K |
| D1206 |
Topical application of fluoride varnish |
255 |
254 |
$4K |
| D0272 |
Bitewings - two radiographic images |
330 |
328 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
191 |
189 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
16 |
12 |
$1K |
| D0330 |
Panoramic radiographic image |
14 |
12 |
$270.00 |