| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
766 |
764 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,334 |
1,065 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
492 |
490 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
338 |
338 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
218 |
97 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,121 |
1,117 |
$13K |
| D1120 |
Prophylaxis - child |
271 |
270 |
$11K |
| D1110 |
Prophylaxis - adult |
40 |
40 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
42 |
26 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
209 |
208 |
$2K |
| D1206 |
Topical application of fluoride varnish |
105 |
105 |
$2K |