| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
896 |
869 |
$21K |
| D1110 |
Prophylaxis - adult |
388 |
373 |
$14K |
| D9110 |
|
489 |
468 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
930 |
870 |
$7K |
| D1120 |
Prophylaxis - child |
126 |
112 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
265 |
246 |
$4K |
| D0274 |
Bitewings - four radiographic images |
153 |
149 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
139 |
98 |
$815.10 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14 |
12 |
$572.24 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$214.34 |