| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,733 |
2,730 |
$94K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
878 |
495 |
$64K |
| D0274 |
Bitewings - four radiographic images |
2,093 |
2,092 |
$61K |
| D1110 |
Prophylaxis - adult |
1,379 |
1,379 |
$60K |
| D1120 |
Prophylaxis - child |
1,477 |
1,477 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
845 |
472 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
3,647 |
3,589 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
712 |
701 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,752 |
1,749 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
993 |
980 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,746 |
2,629 |
$25K |
| D1206 |
Topical application of fluoride varnish |
1,206 |
1,206 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
666 |
666 |
$15K |
| D9110 |
|
121 |
119 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
47 |
39 |
$4K |
| D4346 |
|
26 |
26 |
$3K |
| D1351 |
Sealant - per tooth |
71 |
14 |
$2K |
| D2394 |
|
14 |
12 |
$1K |