| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,047 |
1,040 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,600 |
1,584 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,046 |
1,034 |
$16K |
| D1120 |
Prophylaxis - child |
591 |
581 |
$12K |
| D0274 |
Bitewings - four radiographic images |
234 |
231 |
$5K |
| D0330 |
Panoramic radiographic image |
85 |
85 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
36 |
26 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16 |
16 |
$421.60 |
| D0272 |
Bitewings - two radiographic images |
39 |
39 |
$390.00 |
| D0220 |
Intraoral - periapical first radiographic image |
49 |
48 |
$240.00 |
| D1999 |
|
36 |
29 |
$0.00 |