| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,861 |
1,763 |
$47K |
| D1110 |
Prophylaxis - adult |
975 |
918 |
$39K |
| D1120 |
Prophylaxis - child |
796 |
757 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,097 |
1,037 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,422 |
1,360 |
$21K |
| D0330 |
Panoramic radiographic image |
583 |
539 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
320 |
184 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
224 |
112 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
67 |
60 |
$4K |
| D9110 |
|
96 |
86 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
43 |
42 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
113 |
101 |
$805.92 |
| D0272 |
Bitewings - two radiographic images |
16 |
15 |
$264.81 |