| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,840 |
1,082 |
$104K |
| D0140 |
Limited oral evaluation - problem focused |
1,364 |
498 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,586 |
457 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
703 |
425 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
907 |
666 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
530 |
200 |
$21K |
| D0274 |
Bitewings - four radiographic images |
387 |
207 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
102 |
55 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
100 |
52 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
732 |
717 |
$4K |
| D4910 |
|
41 |
30 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
141 |
119 |
$992.96 |
| D1330 |
|
166 |
164 |
$324.61 |
| D0270 |
|
13 |
13 |
$0.00 |