| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,470 |
1,389 |
$59K |
| D0330 |
Panoramic radiographic image |
1,172 |
1,107 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,596 |
1,516 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
480 |
303 |
$28K |
| D1120 |
Prophylaxis - child |
362 |
349 |
$16K |
| D0274 |
Bitewings - four radiographic images |
537 |
502 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
502 |
471 |
$9K |
| D0272 |
Bitewings - two radiographic images |
591 |
568 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
138 |
93 |
$8K |
| D9110 |
|
234 |
229 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
67 |
40 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
450 |
430 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
157 |
132 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
71 |
60 |
$218.70 |