| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,706 |
3,564 |
$97K |
| D1110 |
Prophylaxis - adult |
4,805 |
4,434 |
$64K |
| D0210 |
Intraoral - complete series of radiographic images |
2,012 |
1,934 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,456 |
2,374 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
973 |
468 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
472 |
464 |
$10K |
| D0330 |
Panoramic radiographic image |
224 |
223 |
$8K |
| D1120 |
Prophylaxis - child |
395 |
394 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
312 |
175 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,839 |
4,510 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
43 |
24 |
$2K |
| D4921 |
|
50 |
38 |
$1K |
| D0274 |
Bitewings - four radiographic images |
1,665 |
1,552 |
$965.33 |
| D8660 |
|
14 |
14 |
$873.36 |
| D0220 |
Intraoral - periapical first radiographic image |
1,154 |
985 |
$548.35 |
| D4355 |
|
44 |
42 |
$534.14 |
| D1330 |
|
4,321 |
3,950 |
$505.46 |
| D0272 |
Bitewings - two radiographic images |
1,045 |
978 |
$283.51 |
| D1999 |
|
23 |
22 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
31 |
31 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
16 |
16 |
$0.00 |