| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
261 |
251 |
$7K |
| D1110 |
Prophylaxis - adult |
182 |
174 |
$7K |
| D0330 |
Panoramic radiographic image |
185 |
173 |
$6K |
| D1206 |
Topical application of fluoride varnish |
244 |
232 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
120 |
116 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
127 |
118 |
$3K |
| D1120 |
Prophylaxis - child |
68 |
67 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
26 |
12 |
$2K |
| D0240 |
|
57 |
27 |
$769.83 |
| D1208 |
Topical application of fluoride, excluding varnish |
41 |
39 |
$663.00 |
| D0220 |
Intraoral - periapical first radiographic image |
61 |
51 |
$569.70 |
| D1999 |
|
486 |
318 |
$0.00 |