| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,080 |
2,064 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,194 |
1,188 |
$67K |
| D1120 |
Prophylaxis - child |
1,543 |
1,510 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,067 |
2,059 |
$38K |
| D1110 |
Prophylaxis - adult |
484 |
484 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
789 |
788 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
404 |
223 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,234 |
1,725 |
$17K |
| D9999 |
Unspecified adjunctive procedure, by report |
148 |
129 |
$17K |
| D4910 |
|
217 |
217 |
$13K |
| D0274 |
Bitewings - four radiographic images |
1,231 |
1,225 |
$12K |
| D9430 |
|
428 |
406 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,306 |
1,272 |
$6K |
| D4341 |
|
122 |
36 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
14 |
$753.90 |
| D1206 |
Topical application of fluoride varnish |
39 |
39 |
$669.00 |
| D0272 |
Bitewings - two radiographic images |
128 |
128 |
$652.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$414.00 |
| D1330 |
|
159 |
158 |
$0.00 |
| D1310 |
|
159 |
158 |
$0.00 |