| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,377 |
1,111 |
$40K |
| D1110 |
Prophylaxis - adult |
2,011 |
798 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
391 |
306 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
2,009 |
864 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,585 |
509 |
$18K |
| D4346 |
|
159 |
145 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
344 |
314 |
$5K |
| D1206 |
Topical application of fluoride varnish |
1,236 |
173 |
$5K |
| D0330 |
Panoramic radiographic image |
78 |
71 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
27 |
14 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23 |
14 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$658.20 |