| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
717 |
715 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
219 |
123 |
$16K |
| D0274 |
Bitewings - four radiographic images |
543 |
540 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
259 |
254 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
609 |
605 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
191 |
104 |
$10K |
| D1110 |
Prophylaxis - adult |
236 |
236 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
480 |
466 |
$5K |
| D1120 |
Prophylaxis - child |
147 |
147 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
80 |
78 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
13 |
$2K |
| D1206 |
Topical application of fluoride varnish |
83 |
83 |
$1K |
| D4346 |
|
12 |
12 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
47 |
47 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
113 |
106 |
$1K |