| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
860 |
849 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
444 |
439 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
642 |
632 |
$30K |
| D9430 |
|
565 |
515 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
179 |
56 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
536 |
529 |
$7K |
| D1120 |
Prophylaxis - child |
109 |
109 |
$6K |
| D1110 |
Prophylaxis - adult |
53 |
53 |
$5K |
| D4910 |
|
42 |
42 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
645 |
315 |
$3K |
| D0274 |
Bitewings - four radiographic images |
110 |
109 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
85 |
84 |
$989.00 |