| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,948 |
1,940 |
$67K |
| D0274 |
Bitewings - four radiographic images |
1,904 |
1,899 |
$54K |
| D1110 |
Prophylaxis - adult |
1,126 |
1,123 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,243 |
1,242 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,884 |
1,843 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,602 |
1,118 |
$18K |
| D0330 |
Panoramic radiographic image |
359 |
358 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
394 |
386 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
86 |
59 |
$6K |
| D1120 |
Prophylaxis - child |
12 |
12 |
$342.34 |
| D0210 |
Intraoral - complete series of radiographic images |
16 |
12 |
$215.96 |