| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
929 |
756 |
$28K |
| D1110 |
Prophylaxis - adult |
798 |
771 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
655 |
617 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
227 |
137 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
658 |
641 |
$14K |
| D0274 |
Bitewings - four radiographic images |
399 |
383 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
461 |
445 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
138 |
135 |
$7K |
| D1120 |
Prophylaxis - child |
140 |
136 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
112 |
60 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
386 |
346 |
$4K |
| D2950 |
|
57 |
26 |
$2K |