| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,197 |
2,944 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
3,375 |
3,128 |
$75K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,730 |
3,507 |
$70K |
| D0274 |
Bitewings - four radiographic images |
1,937 |
1,791 |
$54K |
| D1120 |
Prophylaxis - child |
1,156 |
1,114 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
1,793 |
1,624 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
782 |
721 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
996 |
714 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
334 |
240 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,448 |
1,306 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
167 |
105 |
$10K |
| D0330 |
Panoramic radiographic image |
60 |
37 |
$2K |
| D0270 |
|
49 |
42 |
$204.82 |
| D1999 |
|
37 |
36 |
$0.00 |
| D0180 |
|
14 |
14 |
$0.00 |