| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
855 |
851 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
836 |
824 |
$53K |
| D1120 |
Prophylaxis - child |
797 |
786 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
615 |
612 |
$29K |
| D1110 |
Prophylaxis - adult |
311 |
306 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,403 |
1,458 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,474 |
1,460 |
$18K |
| D0274 |
Bitewings - four radiographic images |
814 |
801 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
182 |
122 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
142 |
98 |
$10K |
| D9430 |
|
189 |
179 |
$6K |
| D0350 |
|
442 |
233 |
$4K |
| D0250 |
|
127 |
117 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
20 |
12 |
$1K |
| D2140 |
|
17 |
14 |
$928.20 |
| D0220 |
Intraoral - periapical first radiographic image |
51 |
51 |
$600.00 |
| D0260 |
|
13 |
12 |
$65.00 |