| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
574 |
458 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
520 |
463 |
$12K |
| D1110 |
Prophylaxis - adult |
277 |
234 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
96 |
55 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
100 |
57 |
$9K |
| D1120 |
Prophylaxis - child |
245 |
196 |
$8K |
| D0330 |
Panoramic radiographic image |
41 |
41 |
$3K |
| D0274 |
Bitewings - four radiographic images |
72 |
57 |
$2K |
| D0272 |
Bitewings - two radiographic images |
88 |
76 |
$2K |
| D9110 |
|
38 |
35 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
16 |
16 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
95 |
72 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
31 |
28 |
$225.05 |
| D1999 |
|
397 |
350 |
$0.00 |