| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
802 |
799 |
$49K |
| D1110 |
Prophylaxis - adult |
443 |
441 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
643 |
640 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,188 |
1,177 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
239 |
238 |
$11K |
| D1120 |
Prophylaxis - child |
297 |
293 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
131 |
77 |
$8K |
| D0274 |
Bitewings - four radiographic images |
196 |
195 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
826 |
509 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
58 |
24 |
$3K |
| D9430 |
|
14 |
14 |
$288.00 |
| D0220 |
Intraoral - periapical first radiographic image |
15 |
14 |
$180.00 |