| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,169 |
2,075 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
3,059 |
2,901 |
$60K |
| D1120 |
Prophylaxis - child |
1,689 |
1,566 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,146 |
1,093 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,066 |
1,932 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
473 |
290 |
$31K |
| D0330 |
Panoramic radiographic image |
731 |
678 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
550 |
505 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
678 |
630 |
$16K |
| D0272 |
Bitewings - two radiographic images |
518 |
485 |
$11K |
| D1206 |
Topical application of fluoride varnish |
294 |
280 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
50 |
49 |
$3K |
| D1351 |
Sealant - per tooth |
210 |
50 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
51 |
28 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
34 |
27 |
$218.65 |
| D1999 |
|
59 |
46 |
$0.00 |