| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
619 |
582 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
496 |
466 |
$12K |
| D0274 |
Bitewings - four radiographic images |
290 |
270 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
140 |
135 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
204 |
196 |
$4K |
| D0330 |
Panoramic radiographic image |
78 |
68 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23 |
14 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
24 |
24 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$533.76 |
| D1999 |
|
19 |
12 |
$39.31 |