| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
818 |
804 |
$36K |
| D1110 |
Prophylaxis - adult |
1,240 |
1,220 |
$36K |
| D4346 |
|
278 |
271 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
207 |
94 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
825 |
815 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
816 |
805 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,444 |
1,422 |
$4K |
| D0350 |
|
1,282 |
974 |
$3K |
| D0274 |
Bitewings - four radiographic images |
818 |
808 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
982 |
960 |
$2K |
| D1330 |
|
1,641 |
1,615 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
150 |
147 |
$1K |
| D9430 |
|
587 |
550 |
$842.66 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$833.15 |
| D0230 |
Intraoral - periapical each additional radiographic image |
860 |
812 |
$741.90 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
13 |
$730.66 |
| D0240 |
|
50 |
43 |
$584.21 |
| D1999 |
|
869 |
858 |
$368.24 |
| D9215 |
|
52 |
41 |
$168.72 |
| D4921 |
|
5,891 |
1,523 |
$91.66 |
| D9911 |
|
304 |
123 |
$60.94 |
| D9951 |
|
207 |
118 |
$31.88 |
| D9630 |
|
328 |
319 |
$0.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
15 |
15 |
$0.00 |
| D9450 |
|
12 |
12 |
$0.00 |