| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
2,083 |
1,967 |
$60K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
880 |
498 |
$59K |
| D0140 |
Limited oral evaluation - problem focused |
2,156 |
1,944 |
$58K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,839 |
2,303 |
$49K |
| D1206 |
Topical application of fluoride varnish |
2,119 |
2,021 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,142 |
997 |
$40K |
| D1110 |
Prophylaxis - adult |
1,097 |
1,046 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,047 |
1,007 |
$25K |
| D0330 |
Panoramic radiographic image |
371 |
306 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,272 |
1,228 |
$15K |
| D1120 |
Prophylaxis - child |
321 |
312 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
100 |
54 |
$8K |
| D3110 |
|
24 |
13 |
$2K |