| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
578 |
569 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
215 |
210 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
208 |
89 |
$8K |
| D0330 |
Panoramic radiographic image |
169 |
164 |
$5K |
| D1110 |
Prophylaxis - adult |
38 |
37 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
273 |
262 |
$2K |
| D1330 |
|
614 |
605 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
14 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
949 |
839 |
$874.07 |
| D1120 |
Prophylaxis - child |
259 |
257 |
$500.73 |
| D0603 |
|
12 |
12 |
$482.49 |
| D0350 |
|
24 |
24 |
$343.01 |
| D0274 |
Bitewings - four radiographic images |
558 |
548 |
$189.46 |
| D0220 |
Intraoral - periapical first radiographic image |
990 |
971 |
$181.97 |
| D1208 |
Topical application of fluoride, excluding varnish |
559 |
549 |
$82.06 |
| D0601 |
|
98 |
97 |
$20.00 |
| D0272 |
Bitewings - two radiographic images |
115 |
114 |
$13.00 |