| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
583 |
554 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
697 |
659 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
523 |
501 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
166 |
162 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
844 |
213 |
$4K |
| D1110 |
Prophylaxis - adult |
187 |
184 |
$4K |
| D1206 |
Topical application of fluoride varnish |
38 |
37 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
47 |
47 |
$878.24 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
13 |
$817.95 |
| D0274 |
Bitewings - four radiographic images |
40 |
40 |
$801.38 |
| D0270 |
|
38 |
38 |
$341.91 |
| D1999 |
|
232 |
187 |
$0.00 |
| D9986 |
|
16 |
16 |
$0.00 |