| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
634 |
629 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
729 |
726 |
$13K |
| D0274 |
Bitewings - four radiographic images |
449 |
443 |
$12K |
| D1120 |
Prophylaxis - child |
302 |
298 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
762 |
448 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
654 |
645 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
93 |
56 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
96 |
57 |
$5K |
| D8660 |
|
16 |
16 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$666.44 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$226.08 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$87.89 |