| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
1,163 |
1,147 |
$19K |
| D1120 |
Prophylaxis - child |
648 |
643 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
1,050 |
1,033 |
$16K |
| D1110 |
Prophylaxis - adult |
409 |
399 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
121 |
120 |
$4K |
| D0274 |
Bitewings - four radiographic images |
161 |
157 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
30 |
13 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
356 |
195 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
272 |
260 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
61 |
59 |
$1K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$701.87 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$241.80 |
| D9994 |
|
21 |
20 |
$0.00 |