| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
473 |
464 |
$34K |
| D0350 |
|
2,394 |
749 |
$24K |
| D1110 |
Prophylaxis - adult |
239 |
233 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
315 |
306 |
$16K |
| D1206 |
Topical application of fluoride varnish |
670 |
662 |
$14K |
| D9430 |
|
375 |
355 |
$12K |
| D4910 |
|
106 |
106 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
111 |
111 |
$8K |
| D1120 |
Prophylaxis - child |
146 |
144 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
100 |
51 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,099 |
298 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
323 |
315 |
$4K |
| D0330 |
Panoramic radiographic image |
96 |
96 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20 |
13 |
$1K |
| D0272 |
Bitewings - two radiographic images |
91 |
91 |
$1K |