| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,214 |
1,166 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
916 |
884 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
950 |
912 |
$21K |
| D1206 |
Topical application of fluoride varnish |
748 |
741 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
576 |
561 |
$8K |
| D9999 |
Unspecified adjunctive procedure, by report |
56 |
55 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,827 |
986 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
1,276 |
1,149 |
$4K |
| D1120 |
Prophylaxis - child |
186 |
172 |
$3K |
| D0272 |
Bitewings - two radiographic images |
964 |
917 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
34 |
25 |
$1K |
| D1310 |
|
177 |
177 |
$46.00 |
| D1330 |
|
117 |
106 |
$0.00 |
| D0603 |
|
24 |
22 |
$0.00 |
| D9986 |
|
13 |
13 |
$0.00 |