| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
361 |
297 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
342 |
286 |
$9K |
| D1110 |
Prophylaxis - adult |
204 |
175 |
$6K |
| D4341 |
|
82 |
28 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
54 |
29 |
$2K |
| D1206 |
Topical application of fluoride varnish |
116 |
106 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
28 |
17 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
38 |
38 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
32 |
29 |
$266.48 |
| D0180 |
|
46 |
35 |
$0.00 |