| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
2,102 |
2,100 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,780 |
1,778 |
$61K |
| D1120 |
Prophylaxis - child |
1,779 |
1,778 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,077 |
3,074 |
$55K |
| D4346 |
|
375 |
375 |
$44K |
| D1110 |
Prophylaxis - adult |
744 |
744 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
2,827 |
2,799 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,367 |
1,365 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,233 |
2,208 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
132 |
83 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
78 |
57 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
125 |
124 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
12 |
$649.09 |