| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
2,426 |
2,378 |
$77K |
| D1110 |
Prophylaxis - adult |
1,770 |
1,721 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
2,442 |
2,369 |
$59K |
| D1120 |
Prophylaxis - child |
1,224 |
1,197 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,159 |
1,144 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
552 |
533 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
111 |
62 |
$11K |
| D0330 |
Panoramic radiographic image |
130 |
120 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
308 |
267 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
375 |
256 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
46 |
36 |
$457.14 |