| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,409 |
2,405 |
$92K |
| D0120 |
Periodic oral evaluation - established patient |
2,848 |
2,845 |
$57K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,080 |
711 |
$50K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,653 |
2,584 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
3,133 |
3,052 |
$25K |
| D2330 |
|
180 |
113 |
$10K |
| D0350 |
|
623 |
622 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
100 |
86 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
174 |
170 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
440 |
439 |
$4K |
| D1120 |
Prophylaxis - child |
143 |
143 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
106 |
105 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
68 |
67 |
$750.32 |
| D2940 |
|
13 |
12 |
$0.00 |