| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,333 |
1,162 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
303 |
265 |
$12K |
| D0274 |
Bitewings - four radiographic images |
1,561 |
1,355 |
$4K |
| D1110 |
Prophylaxis - adult |
549 |
465 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
2,055 |
1,742 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
78 |
41 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,876 |
1,522 |
$1K |
| D1330 |
|
780 |
666 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
49 |
49 |
$751.51 |
| D1120 |
Prophylaxis - child |
85 |
80 |
$352.42 |
| D0272 |
Bitewings - two radiographic images |
48 |
48 |
$68.76 |
| D1206 |
Topical application of fluoride varnish |
144 |
136 |
$0.00 |