| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,545 |
1,536 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
1,560 |
1,550 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,097 |
1,087 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
918 |
914 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
397 |
394 |
$11K |
| D0330 |
Panoramic radiographic image |
113 |
110 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
125 |
69 |
$7K |
| D1120 |
Prophylaxis - child |
247 |
244 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
58 |
52 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
372 |
364 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
51 |
49 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
26 |
14 |
$1K |
| D0272 |
Bitewings - two radiographic images |
68 |
68 |
$900.90 |
| D0230 |
Intraoral - periapical each additional radiographic image |
54 |
29 |
$376.26 |