| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
262 |
254 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
158 |
69 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
327 |
312 |
$10K |
| D1110 |
Prophylaxis - adult |
271 |
264 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
316 |
288 |
$5K |
| D1120 |
Prophylaxis - child |
181 |
166 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
188 |
171 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
31 |
16 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
269 |
68 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
190 |
166 |
$1K |
| D0274 |
Bitewings - four radiographic images |
51 |
45 |
$820.00 |
| D0350 |
|
52 |
34 |
$418.54 |