| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
691 |
661 |
$17K |
| D1110 |
Prophylaxis - adult |
376 |
363 |
$14K |
| D0330 |
Panoramic radiographic image |
230 |
215 |
$10K |
| D0272 |
Bitewings - two radiographic images |
283 |
269 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
27 |
24 |
$2K |
| D9110 |
|
16 |
15 |
$832.65 |
| D9986 |
|
288 |
269 |
$798.00 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$432.90 |
| D0220 |
Intraoral - periapical first radiographic image |
40 |
39 |
$343.00 |
| D0274 |
Bitewings - four radiographic images |
14 |
14 |
$302.40 |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
14 |
$165.00 |