| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,262 |
1,218 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
1,054 |
997 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
1,223 |
1,196 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
357 |
337 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,812 |
1,333 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
246 |
232 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
107 |
77 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
86 |
61 |
$7K |
| D0274 |
Bitewings - four radiographic images |
187 |
186 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
229 |
179 |
$2K |
| D0272 |
Bitewings - two radiographic images |
74 |
70 |
$2K |
| D1120 |
Prophylaxis - child |
13 |
13 |
$586.04 |