| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
903 |
885 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
649 |
644 |
$36K |
| D1120 |
Prophylaxis - child |
621 |
612 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,600 |
1,309 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,146 |
1,129 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
294 |
287 |
$11K |
| D1110 |
Prophylaxis - adult |
151 |
148 |
$11K |
| D0274 |
Bitewings - four radiographic images |
577 |
570 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
56 |
25 |
$3K |
| D9995 |
|
338 |
331 |
$3K |
| D4341 |
|
42 |
12 |
$3K |
| D1320 |
|
42 |
42 |
$667.50 |
| D9999 |
Unspecified adjunctive procedure, by report |
42 |
42 |
$561.40 |
| D9430 |
|
13 |
13 |
$396.00 |
| D0350 |
|
13 |
12 |
$249.60 |
| D1999 |
|
74 |
74 |
$20.00 |
| D0140 |
Limited oral evaluation - problem focused |
16 |
16 |
$0.00 |