| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
426 |
420 |
$14K |
| D0274 |
Bitewings - four radiographic images |
259 |
254 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
301 |
294 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
158 |
156 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
339 |
325 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
50 |
49 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
246 |
239 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
40 |
24 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
27 |
13 |
$1K |
| D1330 |
|
87 |
86 |
$425.00 |
| D1310 |
|
74 |
73 |
$360.00 |