| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,451 |
1,377 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
2,624 |
2,467 |
$45K |
| D1120 |
Prophylaxis - child |
1,231 |
1,151 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,154 |
1,098 |
$17K |
| D0274 |
Bitewings - four radiographic images |
557 |
528 |
$13K |
| D0272 |
Bitewings - two radiographic images |
328 |
306 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
75 |
69 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19 |
12 |
$1K |
| D0330 |
Panoramic radiographic image |
23 |
16 |
$644.70 |
| D0220 |
Intraoral - periapical first radiographic image |
41 |
39 |
$423.25 |
| D0140 |
Limited oral evaluation - problem focused |
17 |
14 |
$366.68 |
| D1999 |
|
1,010 |
866 |
$0.00 |