| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
742 |
734 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
547 |
540 |
$28K |
| D0274 |
Bitewings - four radiographic images |
836 |
827 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
533 |
528 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
655 |
646 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,184 |
1,157 |
$12K |
| D0330 |
Panoramic radiographic image |
220 |
217 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
899 |
876 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
134 |
132 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
31 |
16 |
$5K |
| D2394 |
|
22 |
15 |
$4K |
| D1120 |
Prophylaxis - child |
92 |
92 |
$3K |
| D1330 |
|
48 |
48 |
$288.00 |