| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,098 |
1,054 |
$16K |
| D1110 |
Prophylaxis - adult |
411 |
405 |
$14K |
| D1206 |
Topical application of fluoride varnish |
1,048 |
996 |
$13K |
| D1120 |
Prophylaxis - child |
642 |
601 |
$13K |
| D0330 |
Panoramic radiographic image |
189 |
186 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
102 |
61 |
$6K |
| D0274 |
Bitewings - four radiographic images |
196 |
195 |
$4K |
| D0272 |
Bitewings - two radiographic images |
106 |
104 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
39 |
39 |
$870.98 |
| D0230 |
Intraoral - periapical each additional radiographic image |
36 |
14 |
$294.48 |
| D0220 |
Intraoral - periapical first radiographic image |
15 |
14 |
$153.45 |
| D1999 |
|
455 |
378 |
$0.00 |