| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
927 |
926 |
$58K |
| D1110 |
Prophylaxis - adult |
561 |
560 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
842 |
841 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
481 |
480 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
379 |
181 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
288 |
163 |
$19K |
| D1120 |
Prophylaxis - child |
409 |
409 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,060 |
1,056 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,062 |
584 |
$13K |
| D0350 |
|
1,129 |
452 |
$10K |
| D0274 |
Bitewings - four radiographic images |
376 |
376 |
$8K |
| D9430 |
|
236 |
229 |
$8K |
| D4910 |
|
67 |
67 |
$5K |
| D4341 |
|
43 |
12 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
37 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
67 |
67 |
$2K |
| D1206 |
Topical application of fluoride varnish |
119 |
119 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
26 |
26 |
$312.00 |
| D1999 |
|
15 |
14 |
$0.00 |