| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,249 |
1,241 |
$80K |
| D1110 |
Prophylaxis - adult |
893 |
889 |
$74K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,679 |
3,054 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
953 |
942 |
$58K |
| D1120 |
Prophylaxis - child |
1,041 |
1,039 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,786 |
1,767 |
$38K |
| D4910 |
|
434 |
429 |
$33K |
| D1206 |
Topical application of fluoride varnish |
1,348 |
1,345 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
254 |
136 |
$17K |
| D9430 |
|
525 |
516 |
$17K |
| D0350 |
|
1,194 |
460 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
561 |
560 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
123 |
123 |
$6K |
| D4342 |
|
45 |
12 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
14 |
$982.80 |
| D0220 |
Intraoral - periapical first radiographic image |
41 |
40 |
$486.05 |
| D0272 |
Bitewings - two radiographic images |
24 |
24 |
$285.00 |