| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
382 |
378 |
$25K |
| D1120 |
Prophylaxis - child |
292 |
289 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
226 |
147 |
$15K |
| D9430 |
|
332 |
274 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
132 |
132 |
$10K |
| D0350 |
|
930 |
658 |
$8K |
| D1206 |
Topical application of fluoride varnish |
372 |
368 |
$6K |
| D1320 |
|
491 |
486 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
92 |
51 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
97 |
96 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
830 |
411 |
$3K |
| D0274 |
Bitewings - four radiographic images |
147 |
145 |
$3K |
| D1110 |
Prophylaxis - adult |
25 |
25 |
$2K |