| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
562 |
559 |
$19K |
| D4346 |
|
151 |
149 |
$17K |
| D0274 |
Bitewings - four radiographic images |
348 |
342 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
533 |
522 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
106 |
66 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
445 |
437 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
69 |
69 |
$4K |
| D1110 |
Prophylaxis - adult |
57 |
57 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
50 |
27 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
244 |
231 |
$2K |
| D1120 |
Prophylaxis - child |
67 |
67 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$366.51 |