| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,305 |
7,240 |
$67K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,024 |
1,602 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
5,636 |
5,580 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
2,000 |
1,986 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,246 |
889 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,083 |
2,075 |
$24K |
| D0274 |
Bitewings - four radiographic images |
3,455 |
3,433 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,351 |
5,219 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
5,398 |
5,329 |
$11K |
| D1120 |
Prophylaxis - child |
264 |
261 |
$2K |
| D2335 |
|
38 |
25 |
$972.00 |
| D0140 |
Limited oral evaluation - problem focused |
38 |
37 |
$498.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
44 |
44 |
$238.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$104.50 |