| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
749 |
687 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,029 |
943 |
$23K |
| D0330 |
Panoramic radiographic image |
543 |
494 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
228 |
131 |
$15K |
| D0274 |
Bitewings - four radiographic images |
695 |
642 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
189 |
100 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
254 |
232 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
467 |
426 |
$6K |
| D1120 |
Prophylaxis - child |
162 |
149 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
28 |
13 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
31 |
30 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
70 |
65 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
28 |
26 |
$194.18 |