| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
446 |
446 |
$29K |
| D1110 |
Prophylaxis - adult |
262 |
262 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
362 |
362 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
340 |
340 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
609 |
609 |
$8K |
| D1120 |
Prophylaxis - child |
184 |
184 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,359 |
669 |
$5K |
| D9430 |
|
133 |
127 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
47 |
25 |
$3K |
| D0274 |
Bitewings - four radiographic images |
87 |
87 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
29 |
13 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
131 |
127 |
$2K |
| D0180 |
|
264 |
264 |
$0.00 |