| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,879 |
1,748 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
2,033 |
1,915 |
$75K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
774 |
376 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
1,363 |
1,259 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,965 |
2,875 |
$32K |
| D1110 |
Prophylaxis - adult |
497 |
487 |
$32K |
| D0274 |
Bitewings - four radiographic images |
2,104 |
1,996 |
$23K |
| D1120 |
Prophylaxis - child |
831 |
779 |
$23K |
| D4341 |
|
449 |
144 |
$18K |
| D4910 |
|
233 |
233 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
725 |
676 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
2,192 |
2,018 |
$10K |
| D9430 |
|
161 |
138 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
78 |
39 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
17 |
16 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
12 |
$669.70 |
| D1999 |
|
147 |
108 |
$250.00 |
| D0140 |
Limited oral evaluation - problem focused |
75 |
71 |
$184.80 |
| D0272 |
Bitewings - two radiographic images |
25 |
25 |
$181.00 |
| D0270 |
|
12 |
12 |
$42.50 |