| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,304 |
2,247 |
$88K |
| D0274 |
Bitewings - four radiographic images |
1,581 |
1,526 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
2,066 |
2,019 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
276 |
202 |
$29K |
| D0330 |
Panoramic radiographic image |
371 |
355 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
595 |
565 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
114 |
78 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
150 |
93 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
165 |
154 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
257 |
253 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
231 |
219 |
$3K |
| D2331 |
|
34 |
24 |
$3K |