| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,475 |
1,472 |
$92K |
| D0210 |
Intraoral - complete series of radiographic images |
1,666 |
1,661 |
$76K |
| D1110 |
Prophylaxis - adult |
394 |
389 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
333 |
144 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
256 |
256 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
147 |
69 |
$12K |
| D9430 |
|
350 |
342 |
$11K |
| D1120 |
Prophylaxis - child |
138 |
138 |
$5K |
| D0350 |
|
624 |
166 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
190 |
190 |
$2K |
| D0330 |
Panoramic radiographic image |
1,117 |
1,116 |
$2K |
| D0274 |
Bitewings - four radiographic images |
74 |
74 |
$2K |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$102.00 |