| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
781 |
725 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
998 |
770 |
$28K |
| D1110 |
Prophylaxis - adult |
863 |
802 |
$28K |
| D1206 |
Topical application of fluoride varnish |
467 |
444 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
111 |
53 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
195 |
150 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
213 |
194 |
$4K |
| D0274 |
Bitewings - four radiographic images |
56 |
56 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
168 |
127 |
$1K |
| D9110 |
|
107 |
53 |
$58.50 |