| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
692 |
667 |
$560.00 |
| D1330 |
|
4,780 |
4,444 |
$180.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
495 |
490 |
$94.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,813 |
1,754 |
$62.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,354 |
1,000 |
$26.00 |
| D0274 |
Bitewings - four radiographic images |
1,370 |
1,347 |
$0.00 |
| D0191 |
|
412 |
331 |
$0.00 |
| D2940 |
|
571 |
391 |
$0.00 |
| D1110 |
Prophylaxis - adult |
1,384 |
1,351 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
88 |
63 |
$0.00 |
| D1120 |
Prophylaxis - child |
816 |
797 |
$0.00 |
| D1354 |
|
791 |
424 |
$0.00 |
| D0330 |
Panoramic radiographic image |
26 |
24 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
201 |
172 |
$0.00 |
| D0601 |
|
806 |
780 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,904 |
1,863 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
2,118 |
2,016 |
$0.00 |
| D1320 |
|
448 |
427 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
244 |
229 |
$0.00 |
| D0603 |
|
1,806 |
1,708 |
$0.00 |
| D0602 |
|
1,882 |
1,783 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
58 |
58 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
31 |
28 |
$0.00 |