| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
700 |
679 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
775 |
751 |
$17K |
| D0274 |
Bitewings - four radiographic images |
657 |
640 |
$14K |
| D0330 |
Panoramic radiographic image |
388 |
377 |
$13K |
| D1120 |
Prophylaxis - child |
153 |
149 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
99 |
95 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
153 |
149 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23 |
13 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
128 |
124 |
$498.20 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$81.84 |