| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,216 |
1,185 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
997 |
979 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
245 |
229 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
356 |
341 |
$14K |
| D0274 |
Bitewings - four radiographic images |
373 |
365 |
$13K |
| D1206 |
Topical application of fluoride varnish |
424 |
422 |
$11K |
| D1120 |
Prophylaxis - child |
138 |
138 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
455 |
432 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
50 |
29 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
107 |
96 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
196 |
183 |
$3K |
| D0330 |
Panoramic radiographic image |
16 |
16 |
$1K |
| D1999 |
|
550 |
423 |
$0.00 |