| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
194 |
182 |
$5K |
| D1206 |
Topical application of fluoride varnish |
381 |
356 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
321 |
290 |
$4K |
| D0274 |
Bitewings - four radiographic images |
285 |
246 |
$4K |
| D1120 |
Prophylaxis - child |
178 |
167 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
422 |
371 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
119 |
106 |
$2K |
| D0330 |
Panoramic radiographic image |
125 |
109 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
385 |
267 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
114 |
106 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
29 |
25 |
$1K |
| D0272 |
Bitewings - two radiographic images |
49 |
47 |
$560.82 |
| D0240 |
|
18 |
12 |
$147.31 |