| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
554 |
549 |
$35K |
| D1110 |
Prophylaxis - adult |
385 |
385 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
302 |
200 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
306 |
306 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
187 |
187 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
784 |
768 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,613 |
463 |
$6K |
| D1120 |
Prophylaxis - child |
105 |
103 |
$3K |
| D0274 |
Bitewings - four radiographic images |
101 |
99 |
$2K |
| D0350 |
|
53 |
40 |
$516.00 |
| D0220 |
Intraoral - periapical first radiographic image |
29 |
29 |
$348.00 |