| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,356 |
2,253 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,982 |
2,829 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
976 |
866 |
$25K |
| D1110 |
Prophylaxis - adult |
621 |
590 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,819 |
1,657 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
418 |
380 |
$14K |
| D0274 |
Bitewings - four radiographic images |
988 |
933 |
$12K |
| D4910 |
|
253 |
240 |
$12K |
| D4341 |
|
280 |
67 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
150 |
62 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
99 |
56 |
$7K |
| D1120 |
Prophylaxis - child |
290 |
280 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
130 |
117 |
$6K |
| D1999 |
|
440 |
377 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
41 |
26 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,203 |
988 |
$2K |
| D1330 |
|
124 |
123 |
$0.00 |