| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,072 |
833 |
$27K |
| D1120 |
Prophylaxis - child |
714 |
635 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
522 |
444 |
$24K |
| D1206 |
Topical application of fluoride varnish |
711 |
631 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
1,116 |
960 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,858 |
1,535 |
$19K |
| D0274 |
Bitewings - four radiographic images |
775 |
690 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,422 |
1,135 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
234 |
215 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
60 |
25 |
$3K |
| D1110 |
Prophylaxis - adult |
128 |
117 |
$2K |
| D0330 |
Panoramic radiographic image |
46 |
43 |
$2K |
| D0999 |
Unspecified diagnostic procedure, by report |
38 |
38 |
$1K |
| D9999 |
Unspecified adjunctive procedure, by report |
37 |
37 |
$740.00 |