| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,956 |
2,947 |
$155K |
| D0120 |
Periodic oral evaluation - established patient |
2,481 |
2,467 |
$64K |
| D0274 |
Bitewings - four radiographic images |
1,369 |
1,365 |
$35K |
| D0330 |
Panoramic radiographic image |
674 |
672 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
579 |
578 |
$16K |
| D2331 |
|
57 |
40 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
31 |
27 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
62 |
62 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
27 |
27 |
$326.15 |