| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,323 |
1,111 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,339 |
1,456 |
$35K |
| D1110 |
Prophylaxis - adult |
1,004 |
917 |
$34K |
| D0330 |
Panoramic radiographic image |
637 |
569 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
1,058 |
1,016 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,893 |
1,685 |
$26K |
| D0274 |
Bitewings - four radiographic images |
986 |
883 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
282 |
125 |
$25K |
| D1120 |
Prophylaxis - child |
617 |
552 |
$15K |
| D1206 |
Topical application of fluoride varnish |
923 |
875 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
51 |
27 |
$6K |
| D4355 |
|
45 |
38 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
69 |
65 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
171 |
148 |
$2K |
| D0272 |
Bitewings - two radiographic images |
29 |
28 |
$464.40 |