| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
273 |
238 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
230 |
185 |
$12K |
| D1110 |
Prophylaxis - adult |
167 |
142 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
287 |
246 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
26 |
15 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
104 |
85 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
35 |
31 |
$2K |
| D0330 |
Panoramic radiographic image |
13 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
29 |
28 |
$798.00 |