| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,164 |
1,065 |
$34K |
| D1110 |
Prophylaxis - adult |
538 |
471 |
$17K |
| D1120 |
Prophylaxis - child |
1,296 |
1,197 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
169 |
151 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
441 |
394 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
136 |
77 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,862 |
1,683 |
$5K |
| D0330 |
Panoramic radiographic image |
61 |
49 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
14 |
$604.32 |
| D1354 |
|
97 |
44 |
$537.10 |
| D1330 |
|
1,706 |
1,545 |
$421.73 |
| D0140 |
Limited oral evaluation - problem focused |
35 |
33 |
$418.29 |
| D0274 |
Bitewings - four radiographic images |
229 |
202 |
$381.84 |
| D9999 |
Unspecified adjunctive procedure, by report |
13 |
13 |
$325.00 |
| D0272 |
Bitewings - two radiographic images |
572 |
528 |
$202.56 |
| D0220 |
Intraoral - periapical first radiographic image |
1,087 |
989 |
$182.40 |
| D0230 |
Intraoral - periapical each additional radiographic image |
951 |
866 |
$28.00 |
| D0191 |
|
531 |
485 |
$20.40 |
| D0601 |
|
32 |
31 |
$5.00 |