| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
965 |
925 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,200 |
1,151 |
$27K |
| D1120 |
Prophylaxis - child |
332 |
324 |
$16K |
| D0274 |
Bitewings - four radiographic images |
266 |
257 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
300 |
295 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
116 |
66 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
33 |
24 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
77 |
68 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
30 |
30 |
$2K |
| D0330 |
Panoramic radiographic image |
34 |
33 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
75 |
72 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$154.00 |
| D1330 |
|
21 |
19 |
$0.00 |