| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9944 |
|
425 |
416 |
$138K |
| D0120 |
Periodic oral evaluation - established patient |
4,819 |
4,678 |
$113K |
| D1110 |
Prophylaxis - adult |
3,558 |
3,416 |
$111K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,194 |
5,088 |
$105K |
| D1120 |
Prophylaxis - child |
2,325 |
2,289 |
$98K |
| D0274 |
Bitewings - four radiographic images |
3,104 |
3,020 |
$96K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,688 |
2,852 |
$68K |
| D0140 |
Limited oral evaluation - problem focused |
2,347 |
2,263 |
$64K |
| D9940 |
|
211 |
208 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
3,525 |
3,405 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
341 |
147 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
389 |
381 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
271 |
162 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
237 |
227 |
$10K |
| D0330 |
Panoramic radiographic image |
93 |
92 |
$7K |
| D9999 |
Unspecified adjunctive procedure, by report |
14 |
14 |
$6K |
| D2940 |
|
118 |
78 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
24 |
17 |
$2K |
| D1320 |
|
60 |
60 |
$208.39 |