| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,522 |
1,520 |
$98K |
| D1110 |
Prophylaxis - adult |
692 |
686 |
$61K |
| D0210 |
Intraoral - complete series of radiographic images |
1,030 |
1,029 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
306 |
155 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
358 |
170 |
$19K |
| D1206 |
Topical application of fluoride varnish |
1,133 |
1,124 |
$18K |
| D9430 |
|
356 |
355 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
105 |
105 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,650 |
941 |
$7K |
| D1120 |
Prophylaxis - child |
94 |
94 |
$5K |
| D0274 |
Bitewings - four radiographic images |
135 |
135 |
$3K |
| D0270 |
|
67 |
56 |
$280.00 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$144.00 |
| D0140 |
Limited oral evaluation - problem focused |
16 |
16 |
$0.00 |