| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,729 |
1,721 |
$111K |
| D1110 |
Prophylaxis - adult |
944 |
928 |
$77K |
| D0210 |
Intraoral - complete series of radiographic images |
1,335 |
1,326 |
$63K |
| D1120 |
Prophylaxis - child |
890 |
888 |
$37K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
66 |
40 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
433 |
216 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
476 |
474 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,598 |
854 |
$19K |
| D1206 |
Topical application of fluoride varnish |
927 |
916 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
860 |
857 |
$12K |
| D0274 |
Bitewings - four radiographic images |
257 |
257 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
14 |
$1K |
| D9430 |
|
25 |
24 |
$800.00 |