| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
157 |
145 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
75 |
67 |
$4K |
| D1110 |
Prophylaxis - adult |
95 |
83 |
$3K |
| D0330 |
Panoramic radiographic image |
57 |
54 |
$3K |
| D4355 |
|
41 |
38 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
47 |
47 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
55 |
46 |
$1K |
| D1206 |
Topical application of fluoride varnish |
80 |
75 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
57 |
53 |
$818.80 |
| D0230 |
Intraoral - periapical each additional radiographic image |
42 |
31 |
$684.51 |
| D0274 |
Bitewings - four radiographic images |
16 |
15 |
$432.15 |
| D0272 |
Bitewings - two radiographic images |
16 |
16 |
$309.60 |