| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
822 |
515 |
$24K |
| D1110 |
Prophylaxis - adult |
644 |
410 |
$18K |
| D0330 |
Panoramic radiographic image |
370 |
197 |
$8K |
| D1120 |
Prophylaxis - child |
218 |
173 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
312 |
198 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
431 |
217 |
$4K |
| D0274 |
Bitewings - four radiographic images |
345 |
215 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
191 |
158 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
582 |
312 |
$3K |
| D0272 |
Bitewings - two radiographic images |
113 |
88 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
93 |
45 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
28 |
13 |
$2K |
| D1206 |
Topical application of fluoride varnish |
28 |
19 |
$394.56 |
| D0230 |
Intraoral - periapical each additional radiographic image |
58 |
27 |
$66.12 |
| D1330 |
|
14 |
14 |
$0.00 |