| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,199 |
3,042 |
$104K |
| D0120 |
Periodic oral evaluation - established patient |
4,302 |
4,115 |
$100K |
| D0274 |
Bitewings - four radiographic images |
2,973 |
2,893 |
$95K |
| D1120 |
Prophylaxis - child |
1,682 |
1,646 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,044 |
2,946 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
4,358 |
4,100 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,466 |
3,103 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
1,416 |
1,288 |
$38K |
| D1206 |
Topical application of fluoride varnish |
1,291 |
1,213 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
252 |
149 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
426 |
412 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
305 |
294 |
$17K |
| D0330 |
Panoramic radiographic image |
229 |
211 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
56 |
42 |
$4K |
| D1999 |
|
57 |
51 |
$0.00 |