| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
823 |
755 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,164 |
1,055 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
505 |
456 |
$13K |
| D0330 |
Panoramic radiographic image |
345 |
316 |
$13K |
| D1206 |
Topical application of fluoride varnish |
614 |
569 |
$4K |
| D1120 |
Prophylaxis - child |
327 |
297 |
$3K |
| D1110 |
Prophylaxis - adult |
210 |
187 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
790 |
722 |
$2K |
| D0274 |
Bitewings - four radiographic images |
613 |
564 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
46 |
12 |
$937.71 |
| D0140 |
Limited oral evaluation - problem focused |
93 |
86 |
$853.57 |
| D0220 |
Intraoral - periapical first radiographic image |
1,006 |
928 |
$604.12 |
| D1330 |
|
540 |
500 |
$168.00 |