| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
503 |
502 |
$33K |
| D1110 |
Prophylaxis - adult |
306 |
305 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,379 |
1,364 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
271 |
142 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,289 |
671 |
$18K |
| D1120 |
Prophylaxis - child |
380 |
378 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
326 |
325 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
111 |
111 |
$7K |
| D0274 |
Bitewings - four radiographic images |
198 |
196 |
$4K |
| D0350 |
|
380 |
159 |
$4K |
| D9430 |
|
89 |
86 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
44 |
25 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
25 |
25 |
$297.00 |