| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
809 |
658 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
873 |
673 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
181 |
65 |
$5K |
| D0274 |
Bitewings - four radiographic images |
244 |
190 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
178 |
170 |
$4K |
| D1120 |
Prophylaxis - child |
31 |
27 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
84 |
74 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
48 |
40 |
$1K |
| D0330 |
Panoramic radiographic image |
28 |
24 |
$871.65 |
| D0220 |
Intraoral - periapical first radiographic image |
49 |
38 |
$285.35 |
| D1206 |
Topical application of fluoride varnish |
14 |
14 |
$262.50 |
| D1999 |
|
20 |
16 |
$0.00 |