| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,732 |
3,703 |
$119K |
| D1110 |
Prophylaxis - adult |
2,614 |
2,594 |
$119K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,981 |
1,017 |
$105K |
| D0210 |
Intraoral - complete series of radiographic images |
689 |
683 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
833 |
827 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
945 |
522 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
259 |
176 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,570 |
4,532 |
$6K |
| D1120 |
Prophylaxis - child |
1,985 |
1,968 |
$5K |
| D1330 |
|
4,563 |
4,526 |
$5K |
| D0274 |
Bitewings - four radiographic images |
2,140 |
2,125 |
$2K |
| D0272 |
Bitewings - two radiographic images |
1,397 |
1,388 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
1,137 |
1,107 |
$1K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
95 |
85 |
$874.20 |
| D0230 |
Intraoral - periapical each additional radiographic image |
626 |
608 |
$656.70 |
| D9999 |
Unspecified adjunctive procedure, by report |
15 |
15 |
$375.00 |