| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,412 |
1,389 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
1,070 |
1,062 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
235 |
71 |
$13K |
| D0274 |
Bitewings - four radiographic images |
259 |
256 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
207 |
199 |
$8K |
| D0330 |
Panoramic radiographic image |
97 |
95 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
60 |
56 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
87 |
79 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
30 |
29 |
$841.00 |
| D1999 |
|
89 |
80 |
$0.00 |