| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
997 |
792 |
$46K |
| D1206 |
Topical application of fluoride varnish |
1,749 |
1,472 |
$31K |
| D1120 |
Prophylaxis - child |
612 |
571 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
537 |
389 |
$20K |
| D9999 |
Unspecified adjunctive procedure, by report |
3,101 |
2,429 |
$15K |
| D0274 |
Bitewings - four radiographic images |
542 |
465 |
$15K |
| D0330 |
Panoramic radiographic image |
395 |
355 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
348 |
281 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
99 |
65 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
56 |
51 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
13 |
$1K |
| D0272 |
Bitewings - two radiographic images |
48 |
46 |
$1K |
| D1354 |
|
70 |
12 |
$930.00 |
| D0220 |
Intraoral - periapical first radiographic image |
54 |
52 |
$693.81 |
| D9215 |
|
147 |
130 |
$0.00 |
| D9996 |
|
394 |
380 |
$0.00 |