| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,108 |
1,092 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
977 |
964 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
1,474 |
1,462 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,269 |
2,247 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,893 |
1,703 |
$13K |
| D1120 |
Prophylaxis - child |
1,251 |
1,234 |
$12K |
| D1110 |
Prophylaxis - adult |
1,067 |
1,059 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,813 |
1,785 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
178 |
72 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
83 |
52 |
$3K |
| D0272 |
Bitewings - two radiographic images |
765 |
760 |
$2K |
| D4355 |
|
39 |
38 |
$495.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$440.00 |
| D0140 |
Limited oral evaluation - problem focused |
24 |
24 |
$252.00 |