| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
895 |
889 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
765 |
756 |
$49K |
| D1110 |
Prophylaxis - adult |
419 |
416 |
$36K |
| D1120 |
Prophylaxis - child |
791 |
781 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
491 |
491 |
$23K |
| D1206 |
Topical application of fluoride varnish |
1,348 |
1,333 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
293 |
191 |
$19K |
| D0274 |
Bitewings - four radiographic images |
336 |
333 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,425 |
770 |
$6K |
| D0330 |
Panoramic radiographic image |
176 |
175 |
$5K |
| D9430 |
|
104 |
96 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
12 |
$1K |
| D9440 |
|
19 |
16 |
$112.00 |
| D0270 |
|
12 |
12 |
$60.00 |
| D1999 |
|
15 |
12 |
$10.00 |