| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
745 |
660 |
$28K |
| D0274 |
Bitewings - four radiographic images |
918 |
832 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,090 |
1,001 |
$20K |
| D1110 |
Prophylaxis - adult |
462 |
431 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
335 |
291 |
$7K |
| D1120 |
Prophylaxis - child |
168 |
156 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
398 |
373 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
61 |
24 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
70 |
68 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24 |
13 |
$194.48 |