| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
410 |
406 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
356 |
354 |
$11K |
| D0274 |
Bitewings - four radiographic images |
282 |
282 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
66 |
44 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
377 |
373 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
366 |
361 |
$4K |
| D9110 |
|
60 |
60 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
62 |
62 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
82 |
81 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13 |
12 |
$989.82 |