| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,058 |
980 |
$51K |
| D0210 |
Intraoral - complete series of radiographic images |
576 |
475 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
1,223 |
1,134 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
504 |
441 |
$19K |
| D1206 |
Topical application of fluoride varnish |
935 |
866 |
$16K |
| D0274 |
Bitewings - four radiographic images |
396 |
348 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
108 |
41 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
97 |
91 |
$4K |
| D0330 |
Panoramic radiographic image |
93 |
76 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
175 |
158 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
23 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
45 |
40 |
$1K |
| D1999 |
|
65 |
63 |
$0.00 |