| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,724 |
1,702 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
1,683 |
1,664 |
$41K |
| D0274 |
Bitewings - four radiographic images |
951 |
940 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
384 |
380 |
$17K |
| D1120 |
Prophylaxis - child |
319 |
318 |
$17K |
| D1206 |
Topical application of fluoride varnish |
490 |
489 |
$13K |
| D2740 |
Crown - porcelain/ceramic |
18 |
14 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
288 |
278 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
447 |
403 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
84 |
53 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
42 |
42 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
67 |
67 |
$2K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$796.00 |
| D0272 |
Bitewings - two radiographic images |
15 |
14 |
$372.00 |
| D1999 |
|
606 |
481 |
$0.00 |