| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
893 |
883 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
1,470 |
1,459 |
$22K |
| D1120 |
Prophylaxis - child |
586 |
579 |
$17K |
| D1206 |
Topical application of fluoride varnish |
646 |
636 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
340 |
234 |
$10K |
| D0274 |
Bitewings - four radiographic images |
510 |
503 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
984 |
964 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
391 |
391 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
860 |
713 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
249 |
243 |
$5K |
| D0330 |
Panoramic radiographic image |
33 |
33 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
13 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$273.13 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$0.00 |