| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,924 |
2,772 |
$38K |
| D1110 |
Prophylaxis - adult |
3,182 |
2,984 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,084 |
398 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,669 |
1,535 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
435 |
212 |
$10K |
| D1120 |
Prophylaxis - child |
921 |
871 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,210 |
1,988 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
658 |
596 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
3,086 |
2,739 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,060 |
989 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
523 |
466 |
$5K |
| D0274 |
Bitewings - four radiographic images |
820 |
787 |
$5K |
| D2335 |
|
74 |
25 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
72 |
26 |
$2K |
| D2332 |
|
30 |
12 |
$472.00 |
| D0272 |
Bitewings - two radiographic images |
43 |
42 |
$105.00 |
| D9110 |
|
22 |
12 |
$50.00 |
| D1330 |
|
64 |
49 |
$0.00 |