| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,209 |
2,106 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
2,598 |
2,533 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,158 |
2,145 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,360 |
1,325 |
$31K |
| D1120 |
Prophylaxis - child |
834 |
829 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
525 |
484 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
292 |
289 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
86 |
54 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
400 |
320 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
536 |
392 |
$4K |
| D2950 |
|
25 |
24 |
$3K |
| D1351 |
Sealant - per tooth |
46 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
72 |
72 |
$1K |
| D0330 |
Panoramic radiographic image |
27 |
26 |
$982.66 |
| D0230 |
Intraoral - periapical each additional radiographic image |
103 |
24 |
$659.62 |
| D1999 |
|
166 |
99 |
$0.00 |