| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,475 |
1,448 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,256 |
1,231 |
$35K |
| D1110 |
Prophylaxis - adult |
844 |
829 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,690 |
1,654 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
390 |
168 |
$27K |
| D1120 |
Prophylaxis - child |
688 |
680 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
333 |
330 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
174 |
76 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
398 |
392 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
587 |
581 |
$6K |
| D0330 |
Panoramic radiographic image |
133 |
132 |
$6K |