| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
948 |
869 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
1,010 |
912 |
$22K |
| D1206 |
Topical application of fluoride varnish |
902 |
811 |
$17K |
| D0274 |
Bitewings - four radiographic images |
491 |
451 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
26 |
12 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
70 |
68 |
$2K |
| D0330 |
Panoramic radiographic image |
40 |
38 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
13 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
65 |
64 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
26 |
25 |
$844.47 |
| D1999 |
|
274 |
234 |
$68.00 |