| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,193 |
1,184 |
$78K |
| D1120 |
Prophylaxis - child |
1,071 |
1,065 |
$55K |
| D1110 |
Prophylaxis - adult |
550 |
550 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
835 |
831 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
566 |
565 |
$39K |
| D0350 |
|
3,884 |
1,079 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,729 |
1,713 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
332 |
196 |
$22K |
| D0274 |
Bitewings - four radiographic images |
911 |
905 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
358 |
190 |
$19K |
| D1351 |
Sealant - per tooth |
490 |
119 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,902 |
1,289 |
$12K |
| D9430 |
|
70 |
66 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
56 |
55 |
$669.00 |