| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,326 |
2,249 |
$121K |
| D0120 |
Periodic oral evaluation - established patient |
2,654 |
2,584 |
$62K |
| D0274 |
Bitewings - four radiographic images |
598 |
569 |
$21K |
| D1120 |
Prophylaxis - child |
351 |
350 |
$18K |
| D1206 |
Topical application of fluoride varnish |
523 |
518 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
102 |
75 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
162 |
154 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
49 |
37 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
44 |
40 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
56 |
49 |
$734.00 |
| D9110 |
|
12 |
12 |
$564.00 |
| D1999 |
|
829 |
737 |
$0.00 |