| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,325 |
2,319 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,643 |
1,639 |
$15K |
| D0274 |
Bitewings - four radiographic images |
1,046 |
1,046 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,790 |
1,781 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
429 |
428 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
356 |
356 |
$2K |
| D1120 |
Prophylaxis - child |
132 |
132 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
204 |
204 |
$2K |
| D9310 |
|
18 |
18 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
144 |
144 |
$1K |
| D9110 |
|
104 |
103 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
315 |
245 |
$819.32 |
| D0140 |
Limited oral evaluation - problem focused |
122 |
122 |
$197.43 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$54.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
14 |
$11.48 |