| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,786 |
1,775 |
$81K |
| D0120 |
Periodic oral evaluation - established patient |
1,507 |
1,492 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,099 |
1,028 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
312 |
312 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
215 |
76 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,067 |
1,053 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
241 |
68 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
247 |
247 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
114 |
112 |
$2K |
| D1320 |
|
70 |
69 |
$676.50 |
| D1999 |
|
12 |
12 |
$0.00 |