| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
305 |
302 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
219 |
218 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
584 |
232 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
274 |
266 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
311 |
301 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
93 |
90 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
37 |
27 |
$3K |
| D0274 |
Bitewings - four radiographic images |
82 |
78 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
13 |
$1K |