| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
313 |
308 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
394 |
393 |
$12K |
| D1120 |
Prophylaxis - child |
368 |
366 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,448 |
629 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
125 |
123 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
474 |
472 |
$5K |
| D2140 |
|
61 |
24 |
$3K |
| D0274 |
Bitewings - four radiographic images |
88 |
88 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
86 |
84 |
$936.00 |
| D0272 |
Bitewings - two radiographic images |
84 |
83 |
$817.50 |