| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,654 |
2,529 |
$96K |
| D0330 |
Panoramic radiographic image |
1,197 |
1,138 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
2,047 |
1,958 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,539 |
1,457 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
834 |
800 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
802 |
771 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
99 |
39 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
51 |
28 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
659 |
631 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
626 |
592 |
$4K |
| D1120 |
Prophylaxis - child |
107 |
104 |
$2K |
| D1999 |
|
16 |
16 |
$0.00 |