| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
386 |
375 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
335 |
325 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
161 |
95 |
$13K |
| D4910 |
|
144 |
138 |
$11K |
| D1206 |
Topical application of fluoride varnish |
616 |
613 |
$8K |
| D1110 |
Prophylaxis - adult |
86 |
86 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
188 |
187 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
533 |
460 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
71 |
37 |
$5K |
| D9430 |
|
131 |
123 |
$4K |
| D0274 |
Bitewings - four radiographic images |
202 |
202 |
$4K |
| D4341 |
|
45 |
15 |
$3K |
| D2394 |
|
37 |
27 |
$3K |
| D1120 |
Prophylaxis - child |
32 |
29 |
$810.00 |