| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,254 |
1,252 |
$83K |
| D1110 |
Prophylaxis - adult |
883 |
876 |
$78K |
| D0210 |
Intraoral - complete series of radiographic images |
1,123 |
1,121 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
519 |
515 |
$38K |
| D4910 |
|
485 |
481 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,676 |
1,665 |
$24K |
| D0350 |
|
2,008 |
809 |
$20K |
| D9110 |
|
299 |
275 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,259 |
633 |
$14K |
| D1120 |
Prophylaxis - child |
277 |
276 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
157 |
59 |
$8K |
| D0274 |
Bitewings - four radiographic images |
325 |
325 |
$7K |
| D1320 |
|
329 |
329 |
$5K |
| D9430 |
|
68 |
65 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
24 |
15 |
$2K |
| D2140 |
|
33 |
12 |
$1K |
| D1351 |
Sealant - per tooth |
55 |
15 |
$1K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$144.00 |
| D1330 |
|
24 |
24 |
$0.00 |