| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,781 |
1,777 |
$63K |
| D0274 |
Bitewings - four radiographic images |
1,727 |
1,720 |
$49K |
| D1110 |
Prophylaxis - adult |
995 |
991 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,996 |
1,984 |
$37K |
| D1120 |
Prophylaxis - child |
743 |
735 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,850 |
1,375 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,582 |
1,563 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
319 |
179 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
217 |
149 |
$16K |
| D0330 |
Panoramic radiographic image |
229 |
229 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
391 |
382 |
$9K |
| D2335 |
|
57 |
25 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
67 |
65 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$329.66 |