| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,638 |
1,608 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
1,662 |
1,647 |
$39K |
| D0274 |
Bitewings - four radiographic images |
898 |
883 |
$32K |
| D1120 |
Prophylaxis - child |
510 |
509 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
730 |
727 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
437 |
425 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,042 |
942 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
695 |
624 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
147 |
143 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
32 |
25 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
37 |
36 |
$3K |
| D1999 |
|
893 |
804 |
$0.00 |