| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,656 |
2,652 |
$119K |
| D0120 |
Periodic oral evaluation - established patient |
3,021 |
3,017 |
$68K |
| D0274 |
Bitewings - four radiographic images |
2,310 |
2,309 |
$52K |
| D0210 |
Intraoral - complete series of radiographic images |
329 |
329 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
973 |
973 |
$11K |
| D1120 |
Prophylaxis - child |
231 |
231 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
440 |
436 |
$5K |
| D4341 |
|
31 |
25 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
81 |
81 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
27 |
26 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
12 |
$789.49 |
| D0230 |
Intraoral - periapical each additional radiographic image |
69 |
69 |
$555.34 |
| D0140 |
Limited oral evaluation - problem focused |
37 |
37 |
$416.10 |
| D1999 |
|
1,837 |
1,586 |
$0.00 |