| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
886 |
796 |
$27K |
| D5214 |
|
20 |
19 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
108 |
68 |
$14K |
| D5130 |
|
16 |
15 |
$14K |
| D1110 |
Prophylaxis - adult |
306 |
292 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
676 |
608 |
$10K |
| D5110 |
|
17 |
12 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
278 |
260 |
$5K |
| D0274 |
Bitewings - four radiographic images |
193 |
186 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
194 |
183 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
15 |
$3K |
| D0330 |
Panoramic radiographic image |
72 |
69 |
$2K |
| D5850 |
|
29 |
27 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
14 |
$2K |
| D5851 |
|
14 |
14 |
$1K |
| D1120 |
Prophylaxis - child |
17 |
17 |
$594.18 |
| D0230 |
Intraoral - periapical each additional radiographic image |
31 |
27 |
$261.95 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$237.18 |
| D0270 |
|
13 |
12 |
$219.57 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$205.83 |