| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,616 |
1,604 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
1,236 |
1,221 |
$63K |
| D0210 |
Intraoral - complete series of radiographic images |
1,456 |
1,439 |
$62K |
| D1120 |
Prophylaxis - child |
1,062 |
1,036 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
613 |
226 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,482 |
1,320 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
224 |
84 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
761 |
745 |
$9K |
| D0274 |
Bitewings - four radiographic images |
420 |
388 |
$8K |
| D4341 |
|
91 |
24 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
73 |
35 |
$6K |
| D1110 |
Prophylaxis - adult |
87 |
78 |
$3K |
| D9430 |
|
60 |
56 |
$2K |
| D1351 |
Sealant - per tooth |
100 |
24 |
$2K |
| D4910 |
|
12 |
12 |
$924.00 |
| D9910 |
|
483 |
94 |
$421.40 |
| D0272 |
Bitewings - two radiographic images |
26 |
25 |
$264.00 |
| D0140 |
Limited oral evaluation - problem focused |
25 |
25 |
$0.00 |