| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
828 |
828 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
780 |
457 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
470 |
470 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
635 |
357 |
$35K |
| D4910 |
|
413 |
411 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
568 |
568 |
$27K |
| D1110 |
Prophylaxis - adult |
186 |
185 |
$16K |
| D0274 |
Bitewings - four radiographic images |
477 |
477 |
$10K |
| D1120 |
Prophylaxis - child |
147 |
147 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,436 |
688 |
$6K |
| D4342 |
|
58 |
29 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
145 |
145 |
$2K |
| D9430 |
|
54 |
52 |
$2K |
| D1999 |
|
31 |
30 |
$25.00 |