| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,076 |
2,075 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
1,969 |
1,965 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,452 |
1,452 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,168 |
2,147 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,544 |
1,522 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
693 |
693 |
$15K |
| D1120 |
Prophylaxis - child |
362 |
361 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
986 |
984 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
257 |
257 |
$10K |
| D4341 |
|
117 |
44 |
$4K |
| D0272 |
Bitewings - two radiographic images |
316 |
315 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
14 |
$849.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$128.60 |
| D1320 |
|
15 |
15 |
$20.50 |
| D1330 |
|
18 |
18 |
$0.00 |