| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,779 |
1,746 |
$74K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,670 |
2,627 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
2,036 |
2,009 |
$48K |
| D1120 |
Prophylaxis - child |
879 |
861 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
450 |
439 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,004 |
983 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
313 |
165 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
555 |
540 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
60 |
38 |
$4K |
| D4355 |
|
12 |
12 |
$680.75 |
| D0140 |
Limited oral evaluation - problem focused |
31 |
31 |
$659.29 |
| D0272 |
Bitewings - two radiographic images |
27 |
26 |
$472.03 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
12 |
$142.16 |
| D1999 |
|
54 |
49 |
$0.00 |