| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
957 |
918 |
$29K |
| D1110 |
Prophylaxis - adult |
721 |
684 |
$26K |
| D1120 |
Prophylaxis - child |
496 |
491 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
693 |
684 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
336 |
318 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
165 |
41 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
466 |
462 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
117 |
25 |
$7K |
| D0330 |
Panoramic radiographic image |
99 |
74 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
125 |
111 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
208 |
189 |
$2K |