| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
832 |
820 |
$27K |
| D0274 |
Bitewings - four radiographic images |
678 |
667 |
$19K |
| D1110 |
Prophylaxis - adult |
446 |
436 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
330 |
322 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,296 |
1,258 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
209 |
114 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
925 |
872 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
435 |
423 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
259 |
254 |
$7K |
| D1120 |
Prophylaxis - child |
152 |
146 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
13 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
59 |
53 |
$872.09 |
| D0270 |
|
12 |
12 |
$102.82 |