| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,422 |
1,420 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
2,423 |
2,420 |
$52K |
| D2332 |
|
734 |
694 |
$48K |
| D0272 |
Bitewings - two radiographic images |
2,275 |
2,274 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,435 |
2,407 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,156 |
2,156 |
$11K |
| D1120 |
Prophylaxis - child |
344 |
344 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
458 |
458 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
90 |
66 |
$3K |
| D2140 |
|
12 |
12 |
$580.37 |
| D1999 |
|
311 |
265 |
$0.00 |