| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,570 |
5,563 |
$219K |
| D2750 |
|
357 |
254 |
$211K |
| D0274 |
Bitewings - four radiographic images |
4,767 |
4,767 |
$98K |
| D0120 |
Periodic oral evaluation - established patient |
4,034 |
4,030 |
$83K |
| D0220 |
Intraoral - periapical first radiographic image |
7,501 |
7,205 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
701 |
523 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,124 |
2,123 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
817 |
530 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,638 |
6,480 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,833 |
1,832 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
885 |
757 |
$20K |
| D1120 |
Prophylaxis - child |
471 |
471 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
1,341 |
1,262 |
$13K |
| D2954 |
|
27 |
25 |
$4K |
| D1206 |
Topical application of fluoride varnish |
29 |
29 |
$588.60 |
| D1310 |
|
140 |
139 |
$0.00 |
| D1330 |
|
521 |
521 |
$0.00 |