| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
726 |
708 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
484 |
477 |
$13K |
| D1110 |
Prophylaxis - adult |
198 |
194 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
77 |
27 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
46 |
24 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
150 |
150 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
411 |
183 |
$1K |
| D4341 |
|
51 |
12 |
$1K |
| D9430 |
|
31 |
27 |
$966.00 |
| D0220 |
Intraoral - periapical first radiographic image |
69 |
66 |
$735.00 |
| D0274 |
Bitewings - four radiographic images |
58 |
55 |
$700.20 |
| D0120 |
Periodic oral evaluation - established patient |
56 |
52 |
$383.00 |