| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
719 |
711 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
358 |
345 |
$8K |
| D0274 |
Bitewings - four radiographic images |
429 |
421 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
671 |
632 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
588 |
483 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
388 |
386 |
$3K |
| D1206 |
Topical application of fluoride varnish |
86 |
86 |
$756.84 |
| D0140 |
Limited oral evaluation - problem focused |
36 |
34 |
$419.64 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
12 |
$0.00 |