| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
3,787 |
1,995 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
616 |
613 |
$35K |
| D1110 |
Prophylaxis - adult |
370 |
360 |
$28K |
| D1120 |
Prophylaxis - child |
747 |
723 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,087 |
1,069 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,697 |
1,660 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
249 |
82 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
262 |
238 |
$12K |
| D4910 |
|
149 |
149 |
$11K |
| D0350 |
|
182 |
125 |
$6K |
| D9430 |
|
144 |
133 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
28 |
12 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
26 |
$1K |
| D1320 |
|
29 |
29 |
$360.00 |