| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
759 |
679 |
$592K |
| D1110 |
Prophylaxis - adult |
4,057 |
4,056 |
$213K |
| D0120 |
Periodic oral evaluation - established patient |
4,143 |
4,141 |
$110K |
| D0274 |
Bitewings - four radiographic images |
2,010 |
2,010 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
4,009 |
3,939 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,408 |
1,407 |
$41K |
| D1120 |
Prophylaxis - child |
954 |
953 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
472 |
415 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
1,774 |
1,702 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,585 |
2,578 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
149 |
140 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
363 |
360 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
410 |
410 |
$6K |
| D9110 |
|
43 |
42 |
$938.38 |
| D0272 |
Bitewings - two radiographic images |
55 |
55 |
$852.54 |
| D1999 |
|
195 |
176 |
$0.00 |