| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,011 |
908 |
$22K |
| D1110 |
Prophylaxis - adult |
458 |
415 |
$16K |
| D0272 |
Bitewings - two radiographic images |
948 |
860 |
$12K |
| D0330 |
Panoramic radiographic image |
318 |
290 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
47 |
24 |
$2K |
| D9110 |
|
91 |
86 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
45 |
24 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
127 |
116 |
$901.36 |
| D0120 |
Periodic oral evaluation - established patient |
29 |
28 |
$694.75 |