| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
847 |
847 |
$54K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
534 |
323 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
619 |
619 |
$29K |
| D1120 |
Prophylaxis - child |
911 |
911 |
$26K |
| D1110 |
Prophylaxis - adult |
293 |
293 |
$25K |
| D0350 |
|
2,225 |
709 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
410 |
410 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,246 |
1,246 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
229 |
136 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,914 |
891 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
150 |
112 |
$12K |
| D9430 |
|
219 |
214 |
$7K |
| D0274 |
Bitewings - four radiographic images |
294 |
294 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
507 |
498 |
$6K |
| D9993 |
|
63 |
63 |
$4K |
| D1310 |
|
64 |
64 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
36 |
25 |
$2K |
| D0601 |
|
12 |
12 |
$165.00 |
| D1999 |
|
30 |
25 |
$20.00 |