| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,618 |
1,576 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
2,648 |
2,582 |
$62K |
| D1120 |
Prophylaxis - child |
1,885 |
1,830 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,406 |
2,333 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
614 |
457 |
$34K |
| D0272 |
Bitewings - two radiographic images |
1,970 |
1,909 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
774 |
756 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
789 |
755 |
$9K |
| D0330 |
Panoramic radiographic image |
155 |
152 |
$6K |
| D1206 |
Topical application of fluoride varnish |
186 |
179 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
178 |
170 |
$4K |
| D9110 |
|
59 |
52 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
116 |
110 |
$967.05 |
| D9630 |
|
20 |
20 |
$0.00 |