| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
283 |
282 |
$19K |
| D1110 |
Prophylaxis - adult |
195 |
190 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
258 |
258 |
$14K |
| D0365 |
|
56 |
56 |
$8K |
| D1206 |
Topical application of fluoride varnish |
188 |
187 |
$4K |
| D9110 |
|
44 |
44 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
12 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
57 |
57 |
$996.60 |
| D0220 |
Intraoral - periapical first radiographic image |
62 |
59 |
$881.00 |
| D9430 |
|
15 |
14 |
$534.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
34 |
30 |
$162.90 |