| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
691 |
663 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
724 |
636 |
$16K |
| D0274 |
Bitewings - four radiographic images |
588 |
580 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
342 |
320 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
158 |
105 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
349 |
340 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
997 |
950 |
$6K |
| D1120 |
Prophylaxis - child |
118 |
118 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
94 |
56 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
694 |
340 |
$3K |
| D0330 |
Panoramic radiographic image |
66 |
66 |
$2K |
| D1206 |
Topical application of fluoride varnish |
105 |
105 |
$1K |
| D0272 |
Bitewings - two radiographic images |
42 |
42 |
$656.17 |