| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
784 |
778 |
$50K |
| D0210 |
Intraoral - complete series of radiographic images |
431 |
429 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
195 |
94 |
$13K |
| D1120 |
Prophylaxis - child |
289 |
288 |
$7K |
| D1206 |
Topical application of fluoride varnish |
325 |
323 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
61 |
60 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
736 |
396 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
57 |
28 |
$3K |
| D0274 |
Bitewings - four radiographic images |
75 |
75 |
$1K |
| D9430 |
|
28 |
28 |
$896.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
73 |
73 |
$729.00 |
| D1999 |
|
53 |
44 |
$50.00 |
| D1310 |
|
17 |
17 |
$0.00 |