| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
194 |
105 |
$76K |
| D1110 |
Prophylaxis - adult |
781 |
767 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
962 |
736 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,100 |
1,077 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
657 |
652 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
279 |
266 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
269 |
252 |
$14K |
| D2950 |
|
148 |
75 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
942 |
894 |
$10K |
| D0274 |
Bitewings - four radiographic images |
361 |
357 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
57 |
28 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
685 |
674 |
$6K |
| D0460 |
|
399 |
392 |
$4K |
| D1120 |
Prophylaxis - child |
61 |
56 |
$2K |
| D1206 |
Topical application of fluoride varnish |
31 |
31 |
$772.52 |
| D1330 |
|
27 |
27 |
$162.00 |