| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,580 |
2,558 |
$109K |
| D0120 |
Periodic oral evaluation - established patient |
3,529 |
3,495 |
$85K |
| D1206 |
Topical application of fluoride varnish |
4,015 |
3,984 |
$84K |
| D1120 |
Prophylaxis - child |
1,255 |
1,248 |
$41K |
| D0272 |
Bitewings - two radiographic images |
2,088 |
2,062 |
$37K |
| D0330 |
Panoramic radiographic image |
654 |
646 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
98 |
66 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
98 |
50 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
187 |
186 |
$5K |
| D0274 |
Bitewings - four radiographic images |
145 |
142 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
279 |
254 |
$3K |
| D9110 |
|
43 |
41 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
13 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
18 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
50 |
46 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
45 |
43 |
$947.10 |
| D1999 |
|
14 |
14 |
$0.00 |