| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,142 |
1,811 |
$93K |
| D0210 |
Intraoral - complete series of radiographic images |
1,895 |
1,654 |
$52K |
| D1110 |
Prophylaxis - adult |
737 |
671 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
1,736 |
1,299 |
$44K |
| D0350 |
|
4,869 |
1,955 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,411 |
2,186 |
$17K |
| D0274 |
Bitewings - four radiographic images |
1,356 |
1,277 |
$17K |
| D1120 |
Prophylaxis - child |
840 |
628 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
481 |
225 |
$16K |
| D0330 |
Panoramic radiographic image |
1,843 |
1,613 |
$11K |
| D9430 |
|
2,133 |
1,741 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
256 |
218 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
946 |
632 |
$2K |
| D1206 |
Topical application of fluoride varnish |
81 |
81 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
48 |
26 |
$2K |
| D9995 |
|
240 |
192 |
$2K |
| D0272 |
Bitewings - two radiographic images |
301 |
236 |
$1K |
| D0270 |
|
13 |
13 |
$66.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
46 |
46 |
$47.00 |
| D0140 |
Limited oral evaluation - problem focused |
32 |
29 |
$38.50 |
| D0801 |
|
141 |
141 |
$0.00 |
| D9996 |
|
66 |
37 |
$0.00 |