| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,206 |
6,206 |
$236K |
| D0120 |
Periodic oral evaluation - established patient |
6,216 |
6,216 |
$123K |
| D0274 |
Bitewings - four radiographic images |
6,273 |
6,273 |
$123K |
| D0220 |
Intraoral - periapical first radiographic image |
6,619 |
6,613 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,234 |
6,233 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
249 |
219 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
2,489 |
2,486 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
269 |
269 |
$4K |
| D0330 |
Panoramic radiographic image |
240 |
239 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
24 |
$2K |