| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,140 |
1,797 |
$80K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,282 |
563 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
2,653 |
2,203 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
695 |
323 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
780 |
545 |
$22K |
| D1206 |
Topical application of fluoride varnish |
1,383 |
1,156 |
$20K |
| D0274 |
Bitewings - four radiographic images |
600 |
485 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
781 |
658 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,657 |
1,319 |
$16K |
| D1120 |
Prophylaxis - child |
703 |
600 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,518 |
1,038 |
$12K |
| D0330 |
Panoramic radiographic image |
69 |
61 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$545.80 |
| D0272 |
Bitewings - two radiographic images |
13 |
12 |
$271.91 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
16 |
$173.00 |
| D1999 |
|
129 |
91 |
$60.00 |
| D0190 |
|
81 |
61 |
$0.00 |