| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,220 |
2,174 |
$97K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,846 |
2,807 |
$72K |
| D1120 |
Prophylaxis - child |
1,369 |
1,353 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,284 |
2,258 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
612 |
399 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,244 |
1,215 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
408 |
268 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
576 |
570 |
$15K |
| D0330 |
Panoramic radiographic image |
248 |
238 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
177 |
173 |
$5K |
| D0272 |
Bitewings - two radiographic images |
134 |
133 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
229 |
214 |
$2K |
| D1999 |
|
373 |
317 |
$0.00 |