| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,145 |
1,141 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
609 |
607 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
427 |
236 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
577 |
567 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
331 |
176 |
$17K |
| D1120 |
Prophylaxis - child |
307 |
306 |
$12K |
| D0274 |
Bitewings - four radiographic images |
513 |
499 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,852 |
1,625 |
$8K |
| D9430 |
|
227 |
224 |
$7K |
| D1206 |
Topical application of fluoride varnish |
41 |
41 |
$352.00 |
| D0270 |
|
27 |
27 |
$135.00 |
| D1999 |
|
63 |
59 |
$25.00 |