| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,591 |
2,585 |
$5K |
| D1110 |
Prophylaxis - adult |
1,772 |
1,770 |
$641.60 |
| D0220 |
Intraoral - periapical first radiographic image |
1,627 |
1,619 |
$317.95 |
| D0210 |
Intraoral - complete series of radiographic images |
635 |
635 |
$127.00 |
| D1120 |
Prophylaxis - child |
237 |
237 |
$43.50 |
| D0274 |
Bitewings - four radiographic images |
1,504 |
1,501 |
$41.30 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,475 |
1,469 |
$12.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
889 |
889 |
$11.05 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
95 |
65 |
$0.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$0.00 |
| D9986 |
|
13 |
13 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
39 |
39 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
106 |
84 |
$0.00 |