| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,050 |
2,037 |
$127K |
| D0120 |
Periodic oral evaluation - established patient |
1,722 |
1,715 |
$96K |
| D1120 |
Prophylaxis - child |
2,239 |
2,219 |
$87K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,915 |
2,398 |
$55K |
| D0210 |
Intraoral - complete series of radiographic images |
827 |
824 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,471 |
2,451 |
$34K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
320 |
155 |
$21K |
| D0274 |
Bitewings - four radiographic images |
986 |
982 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
176 |
92 |
$12K |
| D9430 |
|
325 |
298 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
281 |
278 |
$9K |
| D0330 |
Panoramic radiographic image |
301 |
300 |
$9K |
| D1351 |
Sealant - per tooth |
337 |
93 |
$9K |
| D0272 |
Bitewings - two radiographic images |
730 |
722 |
$9K |
| D0340 |
|
98 |
98 |
$5K |
| D1110 |
Prophylaxis - adult |
38 |
38 |
$3K |
| D0350 |
|
363 |
203 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
13 |
$982.80 |
| D2140 |
|
19 |
12 |
$982.80 |