| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,125 |
1,112 |
$41K |
| D0274 |
Bitewings - four radiographic images |
873 |
867 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
686 |
526 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,401 |
1,023 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
733 |
723 |
$11K |
| D0330 |
Panoramic radiographic image |
196 |
137 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
272 |
225 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
253 |
192 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
39 |
12 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
296 |
149 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
40 |
40 |
$498.96 |
| D1999 |
|
13 |
13 |
$0.00 |