| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,832 |
1,817 |
$115K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,037 |
599 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
1,219 |
1,211 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
1,352 |
1,337 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
883 |
458 |
$48K |
| D1110 |
Prophylaxis - adult |
493 |
487 |
$41K |
| D1120 |
Prophylaxis - child |
943 |
941 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,217 |
1,443 |
$21K |
| D0274 |
Bitewings - four radiographic images |
912 |
905 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,214 |
1,207 |
$15K |
| D4341 |
|
152 |
41 |
$11K |