| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,993 |
1,917 |
$80K |
| D0330 |
Panoramic radiographic image |
2,060 |
1,998 |
$74K |
| D0140 |
Limited oral evaluation - problem focused |
1,616 |
1,522 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,850 |
1,778 |
$49K |
| D0272 |
Bitewings - two radiographic images |
2,354 |
2,279 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
174 |
76 |
$8K |
| D2394 |
|
99 |
73 |
$7K |
| D0274 |
Bitewings - four radiographic images |
241 |
225 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
217 |
209 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
177 |
174 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
58 |
25 |
$2K |
| D1120 |
Prophylaxis - child |
41 |
41 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
271 |
250 |
$2K |
| D2335 |
|
19 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
92 |
35 |
$525.62 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$381.25 |
| D1999 |
|
137 |
126 |
$0.00 |