| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,971 |
1,933 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,073 |
1,050 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
1,014 |
996 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
789 |
771 |
$22K |
| D9920 |
|
1,068 |
1,004 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,697 |
1,576 |
$7K |
| D0274 |
Bitewings - four radiographic images |
753 |
740 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
250 |
210 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,304 |
1,231 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
55 |
29 |
$1K |
| D1120 |
Prophylaxis - child |
86 |
86 |
$863.50 |
| D1208 |
Topical application of fluoride, excluding varnish |
107 |
107 |
$823.55 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$266.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$40.00 |
| D1330 |
|
1,127 |
1,073 |
$0.00 |
| D0470 |
|
55 |
54 |
$0.00 |