| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
636 |
636 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
838 |
837 |
$19K |
| D1110 |
Prophylaxis - adult |
599 |
599 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
390 |
303 |
$9K |
| D1206 |
Topical application of fluoride varnish |
958 |
958 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
275 |
205 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
406 |
401 |
$4K |
| D0274 |
Bitewings - four radiographic images |
438 |
437 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
817 |
812 |
$3K |
| D1120 |
Prophylaxis - child |
237 |
237 |
$3K |
| D4910 |
|
121 |
121 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
448 |
448 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
639 |
573 |
$2K |
| D4341 |
|
41 |
24 |
$1K |
| D0603 |
|
68 |
68 |
$253.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
15 |
$252.00 |
| D0270 |
|
12 |
12 |
$11.00 |
| D1330 |
|
65 |
65 |
$10.00 |
| D9986 |
|
446 |
435 |
$0.00 |