| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
965 |
853 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
316 |
307 |
$12K |
| D0274 |
Bitewings - four radiographic images |
562 |
546 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
34 |
12 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
270 |
242 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
826 |
780 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
751 |
662 |
$1K |
| D9430 |
|
1,510 |
1,236 |
$1K |
| D1999 |
|
1,236 |
1,096 |
$912.48 |
| D0140 |
Limited oral evaluation - problem focused |
44 |
44 |
$715.93 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,017 |
896 |
$394.59 |
| D9951 |
|
221 |
126 |
$115.77 |
| D0230 |
Intraoral - periapical each additional radiographic image |
732 |
676 |
$107.03 |
| D4921 |
|
3,774 |
864 |
$98.39 |
| D1330 |
|
1,119 |
988 |
$80.85 |
| D9630 |
|
921 |
795 |
$69.08 |
| D9215 |
|
252 |
155 |
$0.00 |
| D9911 |
|
45 |
15 |
$0.00 |