| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,154 |
1,137 |
$65K |
| D1110 |
Prophylaxis - adult |
897 |
886 |
$64K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
576 |
290 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
736 |
727 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
1,001 |
984 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
780 |
771 |
$16K |
| D1120 |
Prophylaxis - child |
245 |
240 |
$8K |
| D0274 |
Bitewings - four radiographic images |
359 |
357 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
845 |
601 |
$4K |
| D9999 |
Unspecified adjunctive procedure, by report |
26 |
26 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
45 |
25 |
$3K |
| D1999 |
|
839 |
722 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
131 |
130 |
$983.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
14 |
14 |
$840.00 |