| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,046 |
1,007 |
$35K |
| D1110 |
Prophylaxis - adult |
858 |
826 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,147 |
1,117 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,449 |
1,408 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,091 |
1,391 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,552 |
1,488 |
$17K |
| D1120 |
Prophylaxis - child |
58 |
58 |
$2K |
| D4346 |
|
13 |
13 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
12 |
$809.47 |
| D0120 |
Periodic oral evaluation - established patient |
17 |
17 |
$371.11 |