| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,634 |
1,350 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
248 |
247 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
528 |
514 |
$10K |
| D1110 |
Prophylaxis - adult |
254 |
245 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
421 |
393 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
170 |
155 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
282 |
95 |
$3K |
| D2160 |
|
30 |
12 |
$3K |
| D0274 |
Bitewings - four radiographic images |
84 |
79 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
29 |
12 |
$2K |
| D2140 |
|
25 |
12 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15 |
15 |
$720.20 |