| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,718 |
4,713 |
$199K |
| D0120 |
Periodic oral evaluation - established patient |
4,384 |
4,378 |
$96K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,961 |
3,826 |
$72K |
| D0220 |
Intraoral - periapical first radiographic image |
4,811 |
4,706 |
$48K |
| D0330 |
Panoramic radiographic image |
1,375 |
1,374 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
323 |
213 |
$23K |
| D0274 |
Bitewings - four radiographic images |
633 |
632 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
713 |
712 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
203 |
138 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
499 |
484 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
291 |
270 |
$3K |
| D1320 |
|
339 |
339 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
167 |
167 |
$2K |
| D9945 |
|
17 |
16 |
$1K |
| D0272 |
Bitewings - two radiographic images |
27 |
27 |
$436.05 |
| D1999 |
|
235 |
196 |
$0.00 |