| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,002 |
982 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
257 |
134 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
506 |
495 |
$15K |
| D0274 |
Bitewings - four radiographic images |
523 |
522 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
511 |
501 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
125 |
122 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
406 |
397 |
$3K |
| D0330 |
Panoramic radiographic image |
58 |
58 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
360 |
213 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
12 |
$2K |