| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
557 |
546 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
544 |
531 |
$22K |
| D0330 |
Panoramic radiographic image |
374 |
366 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
490 |
476 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
113 |
113 |
$9K |
| D0274 |
Bitewings - four radiographic images |
324 |
316 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
108 |
75 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
329 |
304 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
62 |
44 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
27 |
26 |
$560.00 |