| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,319 |
2,318 |
$128K |
| D0120 |
Periodic oral evaluation - established patient |
3,366 |
3,364 |
$92K |
| D1120 |
Prophylaxis - child |
1,434 |
1,433 |
$59K |
| D0330 |
Panoramic radiographic image |
967 |
966 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,605 |
1,605 |
$22K |
| D0274 |
Bitewings - four radiographic images |
701 |
701 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
198 |
192 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
82 |
80 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
429 |
429 |
$13K |
| D0272 |
Bitewings - two radiographic images |
755 |
755 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
821 |
820 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
257 |
256 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
17 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
26 |
$625.78 |
| D1999 |
|
129 |
129 |
$0.00 |