| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,327 |
1,248 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,605 |
1,524 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
2,079 |
1,928 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
842 |
788 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,023 |
815 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
196 |
192 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
510 |
500 |
$8K |
| D0274 |
Bitewings - four radiographic images |
152 |
145 |
$5K |
| D1120 |
Prophylaxis - child |
167 |
167 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21 |
12 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$900.96 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$205.51 |
| D1330 |
|
116 |
114 |
$0.00 |