| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
532 |
525 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
536 |
533 |
$19K |
| D4341 |
|
190 |
72 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
306 |
305 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
685 |
678 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
358 |
342 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
701 |
688 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
258 |
254 |
$7K |
| D0274 |
Bitewings - four radiographic images |
225 |
220 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
54 |
26 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
406 |
340 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
44 |
26 |
$2K |
| D0603 |
|
123 |
123 |
$1K |
| D0602 |
|
93 |
92 |
$900.00 |
| D0601 |
|
89 |
88 |
$708.00 |
| D0270 |
|
41 |
38 |
$360.00 |