| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
281 |
281 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,047 |
729 |
$15K |
| D0350 |
|
650 |
392 |
$14K |
| D9110 |
|
183 |
104 |
$12K |
| D9430 |
|
213 |
187 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
98 |
58 |
$7K |
| D0274 |
Bitewings - four radiographic images |
279 |
279 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
249 |
224 |
$3K |
| D1120 |
Prophylaxis - child |
81 |
81 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
154 |
154 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
26 |
26 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
13 |
$819.00 |