| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,425 |
1,285 |
$27K |
| D1110 |
Prophylaxis - adult |
792 |
773 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
2,677 |
2,430 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
252 |
124 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
983 |
954 |
$15K |
| D1120 |
Prophylaxis - child |
429 |
410 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
260 |
134 |
$11K |
| D0274 |
Bitewings - four radiographic images |
592 |
575 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,191 |
1,039 |
$7K |
| D1206 |
Topical application of fluoride varnish |
621 |
594 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
257 |
246 |
$5K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$540.16 |
| D2950 |
|
12 |
12 |
$262.76 |
| 01206 |
|
13 |
13 |
$0.00 |