| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,564 |
2,550 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
2,073 |
2,062 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,630 |
2,616 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,544 |
2,858 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,003 |
1,001 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
3,738 |
3,635 |
$11K |
| D0274 |
Bitewings - four radiographic images |
1,339 |
1,334 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
555 |
548 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
178 |
75 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
235 |
235 |
$7K |
| D1120 |
Prophylaxis - child |
167 |
167 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
90 |
52 |
$3K |
| D9920 |
|
170 |
97 |
$2K |
| D2335 |
|
64 |
16 |
$2K |
| D0603 |
|
307 |
307 |
$675.00 |
| D0272 |
Bitewings - two radiographic images |
31 |
31 |
$227.85 |
| D1999 |
|
167 |
132 |
$0.00 |
| D0602 |
|
14 |
14 |
$0.00 |