| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,316 |
1,306 |
$79K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,283 |
219 |
$67K |
| D1110 |
Prophylaxis - adult |
733 |
727 |
$56K |
| D0210 |
Intraoral - complete series of radiographic images |
978 |
967 |
$43K |
| D2330 |
|
213 |
59 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
804 |
798 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
79 |
28 |
$5K |
| D1120 |
Prophylaxis - child |
43 |
43 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
56 |
40 |
$579.15 |
| D0350 |
|
129 |
25 |
$552.80 |
| D0220 |
Intraoral - periapical first radiographic image |
42 |
39 |
$468.00 |