| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
953 |
943 |
$62K |
| D0210 |
Intraoral - complete series of radiographic images |
791 |
782 |
$38K |
| D9430 |
|
1,001 |
855 |
$32K |
| D1110 |
Prophylaxis - adult |
276 |
271 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
296 |
295 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
184 |
67 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
849 |
746 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
588 |
581 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,562 |
1,008 |
$6K |
| D0274 |
Bitewings - four radiographic images |
164 |
164 |
$3K |
| D1206 |
Topical application of fluoride varnish |
130 |
129 |
$2K |
| D1120 |
Prophylaxis - child |
13 |
13 |
$682.50 |
| D1999 |
|
19 |
16 |
$0.00 |