| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
448 |
399 |
$9K |
| D1120 |
Prophylaxis - child |
196 |
177 |
$8K |
| D0274 |
Bitewings - four radiographic images |
383 |
359 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
183 |
172 |
$5K |
| D1110 |
Prophylaxis - adult |
120 |
116 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
557 |
505 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
639 |
582 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
54 |
38 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
14 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
13 |
$647.85 |