| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,961 |
2,959 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
3,424 |
3,422 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
2,749 |
2,569 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
950 |
859 |
$7K |
| D0272 |
Bitewings - two radiographic images |
453 |
453 |
$5K |
| D9110 |
|
206 |
201 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
46 |
29 |
$2K |
| D0274 |
Bitewings - four radiographic images |
69 |
69 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
147 |
147 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
127 |
125 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
24 |
$645.89 |
| D1999 |
|
33 |
28 |
$0.00 |