| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
791 |
752 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,516 |
1,496 |
$55K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
464 |
273 |
$41K |
| D1110 |
Prophylaxis - adult |
772 |
762 |
$39K |
| D1206 |
Topical application of fluoride varnish |
732 |
721 |
$16K |
| D1120 |
Prophylaxis - child |
523 |
518 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
133 |
102 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
556 |
548 |
$15K |
| D0330 |
Panoramic radiographic image |
240 |
236 |
$13K |
| D2740 |
Crown - porcelain/ceramic |
15 |
12 |
$12K |
| D0350 |
|
521 |
515 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
271 |
256 |
$11K |
| D9944 |
|
27 |
27 |
$10K |
| D0274 |
Bitewings - four radiographic images |
330 |
324 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
767 |
733 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
65 |
41 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
724 |
513 |
$6K |
| D0272 |
Bitewings - two radiographic images |
58 |
58 |
$1K |
| D1999 |
|
14 |
14 |
$0.00 |