| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,229 |
1,171 |
$32K |
| D1110 |
Prophylaxis - adult |
490 |
452 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
321 |
129 |
$17K |
| D2394 |
|
276 |
93 |
$17K |
| D0330 |
Panoramic radiographic image |
341 |
310 |
$10K |
| D0274 |
Bitewings - four radiographic images |
348 |
318 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
134 |
74 |
$7K |
| D1120 |
Prophylaxis - child |
123 |
115 |
$6K |
| D1206 |
Topical application of fluoride varnish |
351 |
336 |
$5K |
| D4341 |
|
32 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
153 |
143 |
$953.91 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
27 |
14 |
$831.06 |
| D9110 |
|
33 |
28 |
$674.73 |
| D0230 |
Intraoral - periapical each additional radiographic image |
78 |
41 |
$400.29 |
| D1999 |
|
100 |
97 |
$0.00 |
| D9986 |
|
113 |
112 |
$0.00 |