| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
541 |
525 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
234 |
123 |
$24K |
| D1110 |
Prophylaxis - adult |
257 |
253 |
$17K |
| D0274 |
Bitewings - four radiographic images |
320 |
311 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
735 |
327 |
$7K |
| D1206 |
Topical application of fluoride varnish |
215 |
214 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
48 |
32 |
$5K |
| D1120 |
Prophylaxis - child |
123 |
122 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
469 |
451 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
33 |
30 |
$4K |
| D0330 |
Panoramic radiographic image |
42 |
39 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
77 |
76 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$402.72 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$235.80 |