| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,813 |
1,683 |
$91K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
809 |
711 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,375 |
1,250 |
$30K |
| D0330 |
Panoramic radiographic image |
700 |
602 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
591 |
473 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
240 |
99 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,202 |
1,089 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
857 |
831 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
107 |
39 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
64 |
63 |
$756.48 |
| D1330 |
|
38 |
38 |
$259.20 |