| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,018 |
1,018 |
$67K |
| D0210 |
Intraoral - complete series of radiographic images |
799 |
799 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
139 |
61 |
$9K |
| D1120 |
Prophylaxis - child |
261 |
259 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
119 |
111 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
123 |
44 |
$7K |
| D0350 |
|
635 |
633 |
$6K |
| D0330 |
Panoramic radiographic image |
121 |
121 |
$4K |
| D0274 |
Bitewings - four radiographic images |
158 |
150 |
$3K |
| D1110 |
Prophylaxis - adult |
25 |
25 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
367 |
193 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
46 |
46 |
$318.00 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$144.00 |