| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
201 |
196 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
332 |
314 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
42 |
27 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
267 |
252 |
$2K |
| D1120 |
Prophylaxis - child |
45 |
44 |
$2K |
| D0272 |
Bitewings - two radiographic images |
81 |
72 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
153 |
141 |
$944.97 |
| D1208 |
Topical application of fluoride, excluding varnish |
46 |
45 |
$640.95 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$397.65 |
| D0274 |
Bitewings - four radiographic images |
16 |
16 |
$360.87 |