| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
574 |
410 |
$19K |
| D1110 |
Prophylaxis - adult |
350 |
268 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
351 |
239 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
106 |
28 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
267 |
217 |
$7K |
| D0330 |
Panoramic radiographic image |
129 |
96 |
$4K |
| D0272 |
Bitewings - two radiographic images |
210 |
182 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
92 |
84 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
243 |
141 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
93 |
72 |
$2K |
| D1120 |
Prophylaxis - child |
13 |
13 |
$455.26 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$427.44 |
| D0230 |
Intraoral - periapical each additional radiographic image |
34 |
18 |
$62.10 |