| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
265 |
263 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
130 |
87 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
340 |
339 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
243 |
237 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
64 |
53 |
$10K |
| D1110 |
Prophylaxis - adult |
170 |
170 |
$9K |
| D1206 |
Topical application of fluoride varnish |
302 |
302 |
$8K |
| D1120 |
Prophylaxis - child |
196 |
196 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
228 |
228 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
265 |
259 |
$5K |
| D0274 |
Bitewings - four radiographic images |
66 |
66 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
191 |
167 |
$2K |