| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
776 |
756 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,112 |
1,092 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
446 |
276 |
$25K |
| D0274 |
Bitewings - four radiographic images |
526 |
515 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
133 |
87 |
$9K |
| D0330 |
Panoramic radiographic image |
186 |
181 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
639 |
141 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
115 |
114 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
237 |
228 |
$1K |