| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
772 |
772 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
359 |
200 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
186 |
186 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
924 |
894 |
$10K |
| D0274 |
Bitewings - four radiographic images |
301 |
301 |
$9K |
| D1110 |
Prophylaxis - adult |
152 |
152 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
303 |
303 |
$6K |
| D9110 |
|
95 |
93 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
59 |
39 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
502 |
450 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
136 |
133 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
65 |
38 |
$4K |
| D1120 |
Prophylaxis - child |
88 |
88 |
$3K |