| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4346 |
|
447 |
441 |
$31K |
| D4355 |
|
186 |
183 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
698 |
673 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
355 |
347 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
346 |
333 |
$6K |
| D1206 |
Topical application of fluoride varnish |
395 |
379 |
$5K |
| D1110 |
Prophylaxis - adult |
153 |
144 |
$4K |
| D1120 |
Prophylaxis - child |
175 |
169 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
40 |
27 |
$2K |
| D0330 |
Panoramic radiographic image |
24 |
24 |
$963.75 |
| D0274 |
Bitewings - four radiographic images |
41 |
40 |
$666.20 |
| D1208 |
Topical application of fluoride, excluding varnish |
51 |
49 |
$622.61 |
| D0272 |
Bitewings - two radiographic images |
43 |
38 |
$486.46 |
| D1999 |
|
13 |
12 |
$0.00 |