| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,544 |
1,526 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
974 |
968 |
$995.00 |
| D1120 |
Prophylaxis - child |
563 |
560 |
$625.00 |
| D0274 |
Bitewings - four radiographic images |
750 |
739 |
$580.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,377 |
1,363 |
$575.00 |
| D0210 |
Intraoral - complete series of radiographic images |
599 |
595 |
$566.75 |
| D0220 |
Intraoral - periapical first radiographic image |
2,103 |
1,986 |
$459.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
607 |
602 |
$420.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
49 |
29 |
$385.50 |
| D0140 |
Limited oral evaluation - problem focused |
454 |
402 |
$260.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,673 |
1,610 |
$191.25 |
| D0272 |
Bitewings - two radiographic images |
47 |
45 |
$55.00 |
| D0601 |
|
69 |
67 |
$0.00 |
| D9920 |
|
235 |
228 |
$0.00 |
| D1330 |
|
147 |
128 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
26 |
16 |
$0.00 |