| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,121 |
2,049 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
2,337 |
2,260 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,502 |
1,484 |
$29K |
| D0274 |
Bitewings - four radiographic images |
761 |
744 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
371 |
363 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
637 |
596 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
232 |
130 |
$15K |
| D1120 |
Prophylaxis - child |
111 |
110 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
125 |
122 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
13 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
71 |
67 |
$833.91 |
| D1999 |
|
188 |
177 |
$0.00 |