| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
441 |
421 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
496 |
476 |
$10K |
| D0274 |
Bitewings - four radiographic images |
310 |
298 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
226 |
203 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
432 |
402 |
$4K |
| D1206 |
Topical application of fluoride varnish |
190 |
186 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
49 |
13 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
53 |
51 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
273 |
204 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
69 |
68 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
25 |
12 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
73 |
68 |
$1K |
| D1120 |
Prophylaxis - child |
27 |
26 |
$1K |
| D1330 |
|
47 |
44 |
$0.00 |