| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,196 |
1,135 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,344 |
1,310 |
$21K |
| D9630 |
|
1,435 |
1,412 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,155 |
1,138 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
232 |
117 |
$18K |
| D0274 |
Bitewings - four radiographic images |
610 |
590 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
469 |
403 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
74 |
38 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
70 |
69 |
$5K |
| D1120 |
Prophylaxis - child |
121 |
121 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
219 |
196 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
117 |
95 |
$2K |
| D1999 |
|
33 |
12 |
$0.00 |