| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,991 |
6,983 |
$260K |
| D0120 |
Periodic oral evaluation - established patient |
7,067 |
7,060 |
$138K |
| D0274 |
Bitewings - four radiographic images |
6,625 |
6,622 |
$129K |
| D0220 |
Intraoral - periapical first radiographic image |
8,980 |
8,934 |
$92K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,284 |
7,269 |
$55K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
655 |
583 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
1,577 |
1,576 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
830 |
830 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
367 |
340 |
$15K |
| D1120 |
Prophylaxis - child |
490 |
489 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,136 |
1,135 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
85 |
79 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
797 |
795 |
$7K |
| D0330 |
Panoramic radiographic image |
478 |
478 |
$999.20 |
| D0270 |
|
83 |
83 |
$755.15 |
| D1999 |
|
418 |
385 |
$0.00 |