| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
713 |
264 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
120 |
119 |
$8K |
| D1110 |
Prophylaxis - adult |
145 |
144 |
$7K |
| D1120 |
Prophylaxis - child |
198 |
197 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
226 |
225 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
418 |
415 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
149 |
146 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
56 |
25 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
367 |
358 |
$4K |
| D0274 |
Bitewings - four radiographic images |
69 |
69 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
12 |
$2K |
| D9248 |
|
13 |
13 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
55 |
53 |
$1K |
| D0603 |
|
535 |
527 |
$0.02 |