| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
873 |
853 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,057 |
1,036 |
$25K |
| D1120 |
Prophylaxis - child |
486 |
482 |
$24K |
| D1206 |
Topical application of fluoride varnish |
591 |
588 |
$15K |
| D0274 |
Bitewings - four radiographic images |
401 |
393 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
254 |
249 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
84 |
55 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
330 |
312 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
66 |
38 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
56 |
54 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
24 |
24 |
$928.00 |
| D0272 |
Bitewings - two radiographic images |
24 |
24 |
$704.00 |
| D0603 |
|
293 |
287 |
$0.00 |
| D1999 |
|
540 |
493 |
$0.00 |