| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
842 |
563 |
$12K |
| D0274 |
Bitewings - four radiographic images |
625 |
520 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
754 |
621 |
$8K |
| D1110 |
Prophylaxis - adult |
319 |
270 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
957 |
762 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
553 |
456 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
96 |
53 |
$6K |
| D0330 |
Panoramic radiographic image |
197 |
165 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
466 |
371 |
$3K |
| D1120 |
Prophylaxis - child |
56 |
42 |
$980.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
57 |
42 |
$804.20 |
| D0272 |
Bitewings - two radiographic images |
84 |
69 |
$792.00 |