| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,535 |
2,526 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
2,372 |
2,367 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
1,141 |
1,081 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
974 |
914 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
154 |
154 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
61 |
50 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
78 |
52 |
$3K |
| D0274 |
Bitewings - four radiographic images |
147 |
147 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
68 |
63 |
$344.75 |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$140.00 |