| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
831 |
696 |
$20K |
| D1110 |
Prophylaxis - adult |
629 |
522 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
557 |
459 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
621 |
534 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
129 |
79 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
254 |
217 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
278 |
261 |
$5K |
| D0330 |
Panoramic radiographic image |
216 |
178 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
478 |
387 |
$5K |
| D1120 |
Prophylaxis - child |
33 |
32 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
176 |
102 |
$1K |
| D1206 |
Topical application of fluoride varnish |
20 |
20 |
$530.41 |