| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
604 |
502 |
$28K |
| D1110 |
Prophylaxis - adult |
345 |
341 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
110 |
39 |
$18K |
| D2332 |
|
71 |
25 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
161 |
157 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
361 |
333 |
$4K |
| D1206 |
Topical application of fluoride varnish |
123 |
121 |
$3K |
| D0330 |
Panoramic radiographic image |
68 |
64 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
90 |
90 |
$3K |
| D0274 |
Bitewings - four radiographic images |
117 |
114 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
207 |
199 |
$3K |
| D4341 |
|
35 |
12 |
$2K |