| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
994 |
937 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
531 |
302 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,282 |
1,224 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,021 |
975 |
$20K |
| D1120 |
Prophylaxis - child |
490 |
473 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
141 |
81 |
$8K |
| D0272 |
Bitewings - two radiographic images |
465 |
447 |
$7K |
| D0274 |
Bitewings - four radiographic images |
265 |
243 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
222 |
204 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
244 |
228 |
$3K |
| D0330 |
Panoramic radiographic image |
61 |
61 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
38 |
37 |
$830.58 |
| D0383 |
|
70 |
63 |
$0.00 |