| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
353 |
351 |
$14K |
| D1120 |
Prophylaxis - child |
255 |
246 |
$11K |
| D1110 |
Prophylaxis - adult |
218 |
213 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
188 |
98 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
571 |
564 |
$6K |
| D0330 |
Panoramic radiographic image |
84 |
81 |
$5K |
| D0274 |
Bitewings - four radiographic images |
616 |
589 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
527 |
505 |
$3K |
| D1206 |
Topical application of fluoride varnish |
293 |
287 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
12 |
$875.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23 |
17 |
$758.00 |
| D0220 |
Intraoral - periapical first radiographic image |
565 |
531 |
$547.16 |
| D1330 |
|
592 |
572 |
$468.25 |
| D0140 |
Limited oral evaluation - problem focused |
44 |
42 |
$445.15 |
| D1208 |
Topical application of fluoride, excluding varnish |
79 |
78 |
$272.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
374 |
356 |
$224.24 |