| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
671 |
662 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,053 |
1,019 |
$22K |
| D2740 |
Crown - porcelain/ceramic |
134 |
76 |
$19K |
| D1110 |
Prophylaxis - adult |
495 |
490 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
181 |
119 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
281 |
243 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
77 |
49 |
$4K |
| D0274 |
Bitewings - four radiographic images |
360 |
353 |
$4K |
| D2950 |
|
52 |
28 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
286 |
286 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
13 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
107 |
107 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
197 |
196 |
$839.39 |
| D0230 |
Intraoral - periapical each additional radiographic image |
106 |
54 |
$0.00 |
| D9920 |
|
16 |
16 |
$0.00 |
| D4341 |
|
28 |
13 |
$0.00 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$0.00 |