| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,801 |
1,767 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
1,126 |
1,101 |
$28K |
| D0274 |
Bitewings - four radiographic images |
827 |
808 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,584 |
1,515 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
357 |
347 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
151 |
106 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
231 |
227 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
990 |
936 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
61 |
37 |
$3K |
| D0330 |
Panoramic radiographic image |
58 |
58 |
$1K |
| D0180 |
|
49 |
48 |
$1K |
| D1206 |
Topical application of fluoride varnish |
39 |
39 |
$793.75 |