| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
801 |
797 |
$50K |
| D1110 |
Prophylaxis - adult |
383 |
382 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
694 |
688 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
212 |
114 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
131 |
130 |
$10K |
| D1120 |
Prophylaxis - child |
181 |
180 |
$9K |
| D1206 |
Topical application of fluoride varnish |
531 |
529 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
63 |
27 |
$3K |
| D0350 |
|
519 |
159 |
$3K |
| D9430 |
|
71 |
69 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
137 |
134 |
$2K |
| D0274 |
Bitewings - four radiographic images |
56 |
55 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
113 |
60 |
$449.55 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$144.00 |
| D1330 |
|
41 |
41 |
$0.00 |