| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
977 |
773 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
363 |
287 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
1,108 |
888 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
448 |
382 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
502 |
401 |
$15K |
| D0274 |
Bitewings - four radiographic images |
658 |
506 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
914 |
708 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
62 |
30 |
$5K |
| D1206 |
Topical application of fluoride varnish |
271 |
243 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
483 |
287 |
$3K |
| D0330 |
Panoramic radiographic image |
117 |
82 |
$2K |
| D1120 |
Prophylaxis - child |
45 |
45 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
140 |
106 |
$743.26 |
| D1999 |
|
425 |
354 |
$275.00 |