| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,140 |
1,096 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
590 |
555 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,175 |
1,135 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
468 |
446 |
$22K |
| D0274 |
Bitewings - four radiographic images |
788 |
758 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
568 |
565 |
$18K |
| D0330 |
Panoramic radiographic image |
347 |
344 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,126 |
1,038 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
62 |
47 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
833 |
796 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
14 |
$2K |
| D1330 |
|
16 |
16 |
$115.20 |