| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,081 |
1,051 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
838 |
818 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,206 |
1,062 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
189 |
104 |
$16K |
| D0274 |
Bitewings - four radiographic images |
299 |
291 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
208 |
203 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
574 |
500 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
188 |
187 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
38 |
37 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
12 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
23 |
13 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
46 |
43 |
$2K |
| D1120 |
Prophylaxis - child |
29 |
29 |
$2K |
| D1999 |
|
256 |
206 |
$0.00 |