| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,307 |
1,272 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
711 |
711 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
474 |
440 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
614 |
598 |
$6K |
| D0603 |
|
1,209 |
1,184 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
188 |
181 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
273 |
248 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
1,636 |
1,593 |
$3K |
| D0330 |
Panoramic radiographic image |
1,009 |
979 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,348 |
1,142 |
$2K |
| D0274 |
Bitewings - four radiographic images |
994 |
969 |
$2K |
| D1320 |
|
290 |
284 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
164 |
159 |
$672.00 |
| D2335 |
|
14 |
13 |
$565.00 |
| D1206 |
Topical application of fluoride varnish |
185 |
171 |
$551.00 |
| D0602 |
|
109 |
100 |
$374.00 |
| D1120 |
Prophylaxis - child |
81 |
71 |
$360.00 |
| D0270 |
|
89 |
87 |
$220.00 |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$188.00 |
| D0273 |
|
12 |
12 |
$69.00 |
| D1310 |
|
878 |
820 |
$50.00 |
| D1330 |
|
875 |
816 |
$50.00 |