| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,320 |
1,261 |
$62K |
| D0330 |
Panoramic radiographic image |
670 |
649 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
793 |
763 |
$24K |
| D0274 |
Bitewings - four radiographic images |
879 |
855 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
453 |
423 |
$11K |
| D9110 |
|
113 |
113 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
240 |
218 |
$2K |
| D1120 |
Prophylaxis - child |
19 |
18 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
12 |
$992.20 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
12 |
$559.52 |
| D9986 |
|
102 |
96 |
$291.00 |
| D1206 |
Topical application of fluoride varnish |
18 |
17 |
$281.25 |