| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
824 |
819 |
$54K |
| D0210 |
Intraoral - complete series of radiographic images |
715 |
710 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
327 |
192 |
$21K |
| D9430 |
|
559 |
479 |
$18K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
33 |
25 |
$16K |
| D1110 |
Prophylaxis - adult |
134 |
134 |
$12K |
| D1206 |
Topical application of fluoride varnish |
538 |
534 |
$8K |
| D0330 |
Panoramic radiographic image |
231 |
229 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
89 |
88 |
$6K |
| D1120 |
Prophylaxis - child |
110 |
110 |
$5K |
| D4341 |
|
75 |
28 |
$5K |
| D0350 |
|
375 |
165 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
643 |
306 |
$3K |
| D4910 |
|
24 |
24 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$928.20 |
| D0274 |
Bitewings - four radiographic images |
14 |
14 |
$280.80 |