| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
835 |
828 |
$53K |
| D0210 |
Intraoral - complete series of radiographic images |
497 |
489 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
243 |
240 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,598 |
744 |
$15K |
| D9430 |
|
453 |
388 |
$14K |
| D1120 |
Prophylaxis - child |
289 |
283 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
695 |
684 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
96 |
50 |
$6K |
| D4341 |
|
62 |
16 |
$4K |
| D0274 |
Bitewings - four radiographic images |
202 |
199 |
$4K |
| D1110 |
Prophylaxis - adult |
40 |
40 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
69 |
64 |
$801.00 |
| D1320 |
|
17 |
17 |
$67.50 |
| D0350 |
|
210 |
54 |
$38.40 |