| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
889 |
803 |
$46K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
191 |
84 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
840 |
745 |
$21K |
| D0330 |
Panoramic radiographic image |
281 |
264 |
$18K |
| D1206 |
Topical application of fluoride varnish |
615 |
573 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
101 |
45 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
229 |
220 |
$8K |
| D1120 |
Prophylaxis - child |
133 |
117 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
58 |
55 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
205 |
156 |
$5K |
| D0274 |
Bitewings - four radiographic images |
135 |
98 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$462.00 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
12 |
$214.50 |
| D1999 |
|
55 |
26 |
$0.00 |