| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
232 |
186 |
$115K |
| D4341 |
|
519 |
136 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
753 |
745 |
$51K |
| D1110 |
Prophylaxis - adult |
720 |
717 |
$49K |
| D0330 |
Panoramic radiographic image |
568 |
559 |
$38K |
| D9944 |
|
70 |
70 |
$33K |
| D0274 |
Bitewings - four radiographic images |
873 |
866 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,160 |
1,156 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
545 |
543 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
285 |
276 |
$12K |
| D2954 |
|
124 |
98 |
$10K |
| D0350 |
|
194 |
193 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
53 |
38 |
$7K |
| D0460 |
|
207 |
204 |
$5K |
| D1120 |
Prophylaxis - child |
81 |
81 |
$4K |
| D2950 |
|
14 |
12 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
187 |
180 |
$3K |
| D4910 |
|
14 |
14 |
$924.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
13 |
12 |
$155.50 |