| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
994 |
972 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
629 |
616 |
$14K |
| D0274 |
Bitewings - four radiographic images |
887 |
872 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
435 |
409 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
582 |
571 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
67 |
26 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
296 |
296 |
$4K |
| D0330 |
Panoramic radiographic image |
53 |
51 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
26 |
13 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
256 |
247 |
$2K |