| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,501 |
2,499 |
$136K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
419 |
386 |
$73K |
| D0274 |
Bitewings - four radiographic images |
1,614 |
1,613 |
$44K |
| D2750 |
|
63 |
53 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,383 |
1,383 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,066 |
1,065 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
785 |
780 |
$21K |
| D1320 |
|
2,454 |
2,453 |
$18K |
| D2335 |
|
43 |
42 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
488 |
461 |
$6K |
| D9110 |
|
160 |
155 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
285 |
274 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
173 |
173 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12 |
12 |
$1K |
| D2951 |
|
19 |
13 |
$551.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$263.20 |
| D2950 |
|
15 |
12 |
$0.00 |
| D1999 |
|
31 |
31 |
$0.00 |