| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,172 |
1,160 |
$60K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,201 |
483 |
$57K |
| D2335 |
|
286 |
102 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
409 |
406 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
639 |
324 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
922 |
913 |
$8K |
| D1110 |
Prophylaxis - adult |
1,329 |
1,315 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,532 |
1,516 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
242 |
241 |
$2K |
| D2332 |
|
48 |
27 |
$2K |
| D1330 |
|
1,527 |
1,511 |
$1K |
| D0330 |
Panoramic radiographic image |
105 |
103 |
$1K |
| D0274 |
Bitewings - four radiographic images |
375 |
372 |
$1K |
| D1120 |
Prophylaxis - child |
100 |
100 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
713 |
400 |
$942.94 |
| D0220 |
Intraoral - periapical first radiographic image |
636 |
623 |
$833.34 |