| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,557 |
2,557 |
$118K |
| D0120 |
Periodic oral evaluation - established patient |
2,760 |
2,755 |
$64K |
| D0274 |
Bitewings - four radiographic images |
1,507 |
1,504 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
1,761 |
1,749 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,286 |
1,268 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
165 |
165 |
$2K |
| D0330 |
Panoramic radiographic image |
39 |
39 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14 |
12 |
$906.75 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$548.60 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$258.04 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$127.16 |
| D9999 |
Unspecified adjunctive procedure, by report |
78 |
73 |
$0.00 |
| D1999 |
|
81 |
76 |
$0.00 |