| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,098 |
1,080 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,980 |
977 |
$21K |
| D0272 |
Bitewings - two radiographic images |
819 |
805 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,366 |
1,319 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
772 |
762 |
$12K |
| D1120 |
Prophylaxis - child |
178 |
176 |
$8K |
| D1110 |
Prophylaxis - adult |
93 |
92 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
25 |
12 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
24 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
13 |
$419.10 |
| D0120 |
Periodic oral evaluation - established patient |
13 |
13 |
$357.50 |
| D9986 |
|
264 |
246 |
$0.00 |