| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
831 |
733 |
$37K |
| D1206 |
Topical application of fluoride varnish |
829 |
807 |
$21K |
| D1110 |
Prophylaxis - adult |
282 |
278 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
125 |
122 |
$7K |
| D0330 |
Panoramic radiographic image |
150 |
148 |
$7K |
| D0274 |
Bitewings - four radiographic images |
225 |
221 |
$5K |
| D1120 |
Prophylaxis - child |
117 |
107 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
28 |
12 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
386 |
352 |
$4K |
| D4355 |
|
26 |
25 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
62 |
62 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
262 |
249 |
$2K |
| D3120 |
|
29 |
12 |
$1K |
| D1330 |
|
76 |
68 |
$408.00 |
| D0272 |
Bitewings - two radiographic images |
32 |
24 |
$360.00 |