| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,552 |
2,487 |
$104K |
| D0120 |
Periodic oral evaluation - established patient |
4,232 |
4,156 |
$101K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,633 |
4,556 |
$96K |
| D1120 |
Prophylaxis - child |
2,604 |
2,576 |
$87K |
| D0274 |
Bitewings - four radiographic images |
1,568 |
1,523 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,267 |
2,607 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
2,990 |
2,898 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
378 |
374 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
262 |
207 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
520 |
507 |
$15K |
| D0272 |
Bitewings - two radiographic images |
525 |
523 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12 |
12 |
$893.44 |
| D1206 |
Topical application of fluoride varnish |
27 |
27 |
$590.40 |
| D1999 |
|
19 |
16 |
$0.00 |