| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
802 |
791 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
999 |
992 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
384 |
383 |
$6K |
| D0274 |
Bitewings - four radiographic images |
291 |
289 |
$6K |
| D0330 |
Panoramic radiographic image |
90 |
90 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
74 |
40 |
$4K |
| D1120 |
Prophylaxis - child |
173 |
166 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
29 |
12 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
28 |
28 |
$737.80 |
| D0210 |
Intraoral - complete series of radiographic images |
22 |
18 |
$620.80 |
| D0140 |
Limited oral evaluation - problem focused |
16 |
15 |
$374.84 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$80.00 |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
14 |
$73.00 |