| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,002 |
913 |
$54K |
| D0274 |
Bitewings - four radiographic images |
690 |
654 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
577 |
542 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
933 |
863 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
471 |
445 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,000 |
794 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
91 |
47 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
94 |
80 |
$6K |
| D0330 |
Panoramic radiographic image |
85 |
62 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
21 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
44 |
43 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
12 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
30 |
29 |
$559.75 |
| D1999 |
|
29 |
28 |
$75.00 |