| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
481 |
468 |
$20K |
| D0330 |
Panoramic radiographic image |
579 |
562 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
583 |
565 |
$16K |
| D0274 |
Bitewings - four radiographic images |
732 |
709 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
225 |
141 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
186 |
120 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
466 |
456 |
$11K |
| D1120 |
Prophylaxis - child |
232 |
227 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
342 |
334 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
83 |
83 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
13 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
90 |
88 |
$1K |
| D0180 |
|
48 |
48 |
$0.00 |