| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
469 |
461 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
335 |
309 |
$10K |
| D0274 |
Bitewings - four radiographic images |
305 |
295 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
252 |
251 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
326 |
299 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
85 |
67 |
$954.58 |
| D0140 |
Limited oral evaluation - problem focused |
28 |
27 |
$903.84 |
| D0330 |
Panoramic radiographic image |
19 |
12 |
$647.88 |