| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
686 |
682 |
$45K |
| D0210 |
Intraoral - complete series of radiographic images |
648 |
644 |
$30K |
| D9430 |
|
267 |
256 |
$8K |
| D1320 |
|
438 |
434 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
396 |
396 |
$6K |
| D1120 |
Prophylaxis - child |
106 |
106 |
$5K |
| D0350 |
|
281 |
105 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
36 |
26 |
$2K |
| D1110 |
Prophylaxis - adult |
24 |
24 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
30 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
468 |
106 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
139 |
126 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
26 |
26 |
$2K |
| D2140 |
|
14 |
13 |
$764.40 |
| D0274 |
Bitewings - four radiographic images |
14 |
14 |
$237.60 |