| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
941 |
937 |
$51K |
| D0210 |
Intraoral - complete series of radiographic images |
784 |
781 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
525 |
280 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
452 |
204 |
$23K |
| D1110 |
Prophylaxis - adult |
212 |
212 |
$15K |
| D1120 |
Prophylaxis - child |
499 |
496 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
379 |
377 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
646 |
645 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,605 |
605 |
$6K |
| D0274 |
Bitewings - four radiographic images |
335 |
330 |
$6K |
| D9430 |
|
140 |
128 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
45 |
27 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
31 |
30 |
$360.00 |
| D1206 |
Topical application of fluoride varnish |
28 |
28 |
$235.00 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$140.00 |