| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
867 |
840 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
1,024 |
998 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
283 |
163 |
$15K |
| D0274 |
Bitewings - four radiographic images |
575 |
560 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
504 |
492 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
237 |
230 |
$6K |
| D1120 |
Prophylaxis - child |
296 |
288 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
76 |
50 |
$4K |
| D0330 |
Panoramic radiographic image |
67 |
62 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
27 |
27 |
$519.34 |
| D0272 |
Bitewings - two radiographic images |
39 |
38 |
$380.00 |
| D0220 |
Intraoral - periapical first radiographic image |
76 |
75 |
$355.00 |