| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,060 |
1,054 |
$64K |
| D0210 |
Intraoral - complete series of radiographic images |
1,041 |
1,035 |
$47K |
| D9430 |
|
1,426 |
1,164 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
600 |
236 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
501 |
176 |
$26K |
| D0350 |
|
3,349 |
990 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
383 |
381 |
$13K |
| D1120 |
Prophylaxis - child |
399 |
398 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,885 |
630 |
$12K |
| D1110 |
Prophylaxis - adult |
83 |
83 |
$7K |
| D0274 |
Bitewings - four radiographic images |
370 |
367 |
$6K |
| D1206 |
Topical application of fluoride varnish |
139 |
137 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
107 |
107 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
24 |
24 |
$259.50 |
| D0431 |
|
480 |
480 |
$0.00 |
| D0190 |
|
12 |
12 |
$0.00 |
| D1999 |
|
28 |
26 |
$0.00 |