| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,086 |
1,079 |
$58K |
| D0330 |
Panoramic radiographic image |
462 |
461 |
$31K |
| D0274 |
Bitewings - four radiographic images |
833 |
830 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
845 |
837 |
$27K |
| D1206 |
Topical application of fluoride varnish |
806 |
802 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
621 |
608 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
564 |
563 |
$19K |
| D1120 |
Prophylaxis - child |
205 |
204 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
60 |
42 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
47 |
24 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
275 |
272 |
$4K |
| D0272 |
Bitewings - two radiographic images |
74 |
74 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
18 |
12 |
$2K |
| D1999 |
|
497 |
413 |
$0.00 |