| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
863 |
826 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
960 |
916 |
$24K |
| D0330 |
Panoramic radiographic image |
850 |
808 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,297 |
1,250 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
2,383 |
2,163 |
$16K |
| D9110 |
|
474 |
394 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
827 |
758 |
$15K |
| D0274 |
Bitewings - four radiographic images |
759 |
732 |
$7K |
| D1999 |
|
1,415 |
1,059 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
249 |
243 |
$6K |
| D7250 |
|
91 |
50 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
110 |
52 |
$4K |
| D4341 |
|
164 |
40 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
79 |
40 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,836 |
1,504 |
$3K |
| D0272 |
Bitewings - two radiographic images |
408 |
390 |
$3K |
| D0190 |
|
56 |
51 |
$0.00 |
| D0191 |
|
56 |
51 |
$0.00 |
| D1330 |
|
59 |
58 |
$0.00 |