| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,172 |
1,099 |
$53K |
| D0210 |
Intraoral - complete series of radiographic images |
328 |
306 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
208 |
118 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
358 |
321 |
$12K |
| D0274 |
Bitewings - four radiographic images |
301 |
276 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
351 |
320 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
273 |
244 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
77 |
74 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
62 |
26 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
127 |
103 |
$1K |