| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,002 |
1,000 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
900 |
898 |
$42K |
| D0330 |
Panoramic radiographic image |
559 |
558 |
$16K |
| D9430 |
|
413 |
411 |
$13K |
| D1206 |
Topical application of fluoride varnish |
721 |
714 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
129 |
127 |
$9K |
| D1120 |
Prophylaxis - child |
215 |
215 |
$9K |
| D1110 |
Prophylaxis - adult |
94 |
94 |
$8K |
| D0274 |
Bitewings - four radiographic images |
159 |
156 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
718 |
436 |
$3K |
| D2394 |
|
29 |
15 |
$2K |
| D4910 |
|
13 |
13 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13 |
12 |
$873.60 |
| D0220 |
Intraoral - periapical first radiographic image |
64 |
64 |
$762.05 |