| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
716 |
681 |
$25K |
| D1110 |
Prophylaxis - adult |
672 |
634 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
725 |
696 |
$17K |
| D0330 |
Panoramic radiographic image |
489 |
464 |
$16K |
| D1120 |
Prophylaxis - child |
550 |
536 |
$11K |
| D2940 |
|
206 |
142 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
616 |
602 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
520 |
465 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
28 |
14 |
$2K |
| D0272 |
Bitewings - two radiographic images |
77 |
69 |
$1K |
| D0274 |
Bitewings - four radiographic images |
33 |
31 |
$659.56 |
| D0140 |
Limited oral evaluation - problem focused |
24 |
24 |
$564.75 |