| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
822 |
819 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
663 |
661 |
$28K |
| D1110 |
Prophylaxis - adult |
250 |
249 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
349 |
349 |
$11K |
| D1120 |
Prophylaxis - child |
331 |
329 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,894 |
509 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
641 |
639 |
$6K |
| D0274 |
Bitewings - four radiographic images |
230 |
230 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
67 |
40 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
68 |
36 |
$3K |
| D9430 |
|
72 |
69 |
$2K |
| D0330 |
Panoramic radiographic image |
35 |
34 |
$771.00 |
| D0220 |
Intraoral - periapical first radiographic image |
61 |
61 |
$606.00 |