| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
689 |
615 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
446 |
180 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
772 |
664 |
$12K |
| D0330 |
Panoramic radiographic image |
365 |
307 |
$11K |
| D1110 |
Prophylaxis - adult |
343 |
271 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
868 |
772 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
269 |
220 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
64 |
48 |
$3K |
| D0272 |
Bitewings - two radiographic images |
203 |
183 |
$3K |
| D0274 |
Bitewings - four radiographic images |
192 |
137 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
42 |
34 |
$961.95 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$99.96 |
| D1999 |
|
331 |
268 |
$0.00 |