| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,577 |
1,572 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
1,339 |
1,334 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
857 |
852 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,197 |
1,184 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
227 |
222 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21 |
12 |
$2K |
| D0274 |
Bitewings - four radiographic images |
116 |
116 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
66 |
66 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
84 |
84 |
$548.74 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$332.44 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$112.10 |
| D1999 |
|
96 |
94 |
$0.00 |