| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
613 |
575 |
$21K |
| D0274 |
Bitewings - four radiographic images |
486 |
453 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
551 |
539 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
412 |
371 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
547 |
527 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
676 |
626 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
194 |
143 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
506 |
283 |
$5K |
| D2332 |
|
43 |
12 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
48 |
24 |
$3K |