| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,199 |
1,117 |
$30K |
| D1110 |
Prophylaxis - adult |
837 |
815 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
772 |
760 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
925 |
899 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,110 |
1,051 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
208 |
203 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
638 |
330 |
$6K |
| D0274 |
Bitewings - four radiographic images |
211 |
209 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
43 |
28 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
83 |
79 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$1K |
| D0270 |
|
86 |
83 |
$587.72 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$586.04 |
| D2940 |
|
13 |
13 |
$338.00 |