| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
7,701 |
2,621 |
$91K |
| D1110 |
Prophylaxis - adult |
2,012 |
1,974 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
2,902 |
2,868 |
$76K |
| D0220 |
Intraoral - periapical first radiographic image |
3,123 |
3,040 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,504 |
2,474 |
$43K |
| D1120 |
Prophylaxis - child |
1,390 |
1,373 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
349 |
167 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
583 |
564 |
$25K |
| D0274 |
Bitewings - four radiographic images |
731 |
716 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
142 |
94 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
54 |
24 |
$5K |
| D0330 |
Panoramic radiographic image |
80 |
77 |
$4K |
| D0272 |
Bitewings - two radiographic images |
234 |
233 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
44 |
44 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
52 |
52 |
$2K |