| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
947 |
944 |
$62K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
910 |
465 |
$60K |
| D1110 |
Prophylaxis - adult |
504 |
504 |
$45K |
| D0210 |
Intraoral - complete series of radiographic images |
821 |
820 |
$39K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
451 |
294 |
$36K |
| D1120 |
Prophylaxis - child |
595 |
592 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
398 |
233 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
257 |
256 |
$20K |
| D0350 |
|
2,148 |
678 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,147 |
1,145 |
$18K |
| D9430 |
|
364 |
358 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,285 |
475 |
$5K |
| D0274 |
Bitewings - four radiographic images |
191 |
191 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
251 |
249 |
$3K |