| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,584 |
2,504 |
$130K |
| D0120 |
Periodic oral evaluation - established patient |
2,232 |
2,171 |
$48K |
| D0274 |
Bitewings - four radiographic images |
972 |
949 |
$33K |
| D1206 |
Topical application of fluoride varnish |
436 |
427 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
133 |
131 |
$9K |
| D1120 |
Prophylaxis - child |
200 |
197 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
187 |
183 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
100 |
65 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
149 |
142 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
308 |
294 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
13 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
18 |
18 |
$435.38 |
| D1999 |
|
93 |
80 |
$0.00 |