| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
829 |
819 |
$26K |
| D0274 |
Bitewings - four radiographic images |
919 |
907 |
$24K |
| D9110 |
|
493 |
462 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
692 |
684 |
$13K |
| D0330 |
Panoramic radiographic image |
305 |
302 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,314 |
1,284 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,191 |
1,172 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
420 |
418 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
230 |
228 |
$3K |
| D1120 |
Prophylaxis - child |
99 |
98 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21 |
13 |
$1K |
| D0272 |
Bitewings - two radiographic images |
30 |
30 |
$465.92 |