| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,009 |
1,006 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
207 |
205 |
$12K |
| D0274 |
Bitewings - four radiographic images |
215 |
214 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
523 |
515 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
67 |
37 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
267 |
265 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
150 |
146 |
$4K |
| D1110 |
Prophylaxis - adult |
95 |
94 |
$4K |
| D0340 |
|
78 |
78 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
55 |
24 |
$3K |
| D1120 |
Prophylaxis - child |
54 |
54 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
110 |
110 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
28 |
25 |
$583.53 |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$529.91 |