| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,835 |
1,701 |
$75K |
| D0220 |
Intraoral - periapical first radiographic image |
3,300 |
3,031 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,737 |
1,813 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
422 |
204 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
1,250 |
1,149 |
$42K |
| D1110 |
Prophylaxis - adult |
1,137 |
1,091 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,061 |
986 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
1,070 |
1,026 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
384 |
342 |
$21K |
| D1206 |
Topical application of fluoride varnish |
1,066 |
1,015 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
71 |
41 |
$8K |
| D1120 |
Prophylaxis - child |
218 |
210 |
$6K |
| D0330 |
Panoramic radiographic image |
71 |
61 |
$3K |
| D0270 |
|
343 |
299 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
44 |
42 |
$745.97 |