| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
860 |
857 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
935 |
931 |
$62K |
| D0210 |
Intraoral - complete series of radiographic images |
783 |
779 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
355 |
142 |
$19K |
| D9430 |
|
603 |
581 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
188 |
80 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
140 |
140 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,459 |
867 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
361 |
358 |
$4K |
| D1120 |
Prophylaxis - child |
37 |
37 |
$2K |
| D0274 |
Bitewings - four radiographic images |
82 |
82 |
$2K |
| D1999 |
|
34 |
32 |
$10.00 |