| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,834 |
3,832 |
$82K |
| D0120 |
Periodic oral evaluation - established patient |
5,763 |
5,757 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,025 |
3,932 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
2,256 |
2,202 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
4,001 |
3,955 |
$20K |
| D1120 |
Prophylaxis - child |
1,424 |
1,424 |
$12K |
| D0274 |
Bitewings - four radiographic images |
1,588 |
1,588 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,146 |
2,146 |
$6K |
| D4341 |
|
47 |
26 |
$3K |
| D2954 |
|
14 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
334 |
334 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
21 |
$879.82 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
23 |
23 |
$365.98 |
| D0330 |
Panoramic radiographic image |
211 |
211 |
$340.00 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$30.20 |