| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,378 |
1,316 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
1,836 |
1,780 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,009 |
1,936 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,615 |
1,216 |
$30K |
| D1120 |
Prophylaxis - child |
845 |
812 |
$23K |
| D0274 |
Bitewings - four radiographic images |
754 |
704 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,476 |
1,361 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
153 |
122 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
202 |
182 |
$8K |
| D0330 |
Panoramic radiographic image |
155 |
150 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
66 |
56 |
$5K |
| D0272 |
Bitewings - two radiographic images |
282 |
268 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
27 |
26 |
$935.32 |
| D1999 |
|
927 |
847 |
$0.00 |