| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,331 |
1,257 |
$69K |
| D0140 |
Limited oral evaluation - problem focused |
1,196 |
1,099 |
$47K |
| D0274 |
Bitewings - four radiographic images |
907 |
848 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,044 |
983 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
153 |
82 |
$14K |
| D0330 |
Panoramic radiographic image |
135 |
125 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
80 |
52 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
99 |
97 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
177 |
154 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
44 |
43 |
$2K |
| D3120 |
|
44 |
28 |
$0.00 |