| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,175 |
1,123 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
1,252 |
1,198 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
767 |
734 |
$21K |
| D1110 |
Prophylaxis - adult |
790 |
726 |
$18K |
| D0274 |
Bitewings - four radiographic images |
1,040 |
993 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
236 |
66 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
756 |
714 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,966 |
1,540 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,195 |
1,049 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
139 |
38 |
$6K |
| D1120 |
Prophylaxis - child |
218 |
209 |
$5K |
| D1206 |
Topical application of fluoride varnish |
141 |
132 |
$2K |
| D4341 |
|
79 |
19 |
$850.00 |
| D9910 |
|
12 |
12 |
$421.40 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$285.50 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$115.50 |