| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
2,060 |
1,778 |
$57K |
| D1110 |
Prophylaxis - adult |
1,550 |
1,493 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,488 |
2,410 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,028 |
993 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,383 |
1,346 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
370 |
358 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
208 |
202 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
698 |
660 |
$8K |
| D1120 |
Prophylaxis - child |
134 |
132 |
$6K |
| D0330 |
Panoramic radiographic image |
28 |
24 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
133 |
68 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
12 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
14 |
$1K |
| D1320 |
|
13 |
13 |
$54.99 |