| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
981 |
956 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,381 |
1,348 |
$34K |
| D0330 |
Panoramic radiographic image |
347 |
332 |
$13K |
| D0272 |
Bitewings - two radiographic images |
548 |
533 |
$10K |
| D9110 |
|
111 |
102 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
170 |
164 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
58 |
38 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
94 |
64 |
$2K |
| D9986 |
|
476 |
435 |
$1K |
| D2394 |
|
18 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
38 |
38 |
$926.90 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12 |
12 |
$638.00 |
| D0220 |
Intraoral - periapical first radiographic image |
62 |
56 |
$535.60 |