| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
995 |
992 |
$65K |
| D1110 |
Prophylaxis - adult |
542 |
540 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
506 |
503 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
758 |
755 |
$36K |
| D1120 |
Prophylaxis - child |
474 |
473 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,401 |
1,397 |
$19K |
| D0274 |
Bitewings - four radiographic images |
313 |
313 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,000 |
496 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
62 |
25 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
37 |
13 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
40 |
15 |
$2K |
| D1351 |
Sealant - per tooth |
57 |
13 |
$2K |
| D1330 |
|
17 |
17 |
$0.00 |