| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,318 |
2,172 |
$124K |
| D0274 |
Bitewings - four radiographic images |
2,118 |
1,953 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
2,298 |
2,155 |
$54K |
| D1120 |
Prophylaxis - child |
843 |
823 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
626 |
578 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,022 |
896 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
279 |
172 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
299 |
282 |
$20K |
| D1206 |
Topical application of fluoride varnish |
745 |
744 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
889 |
854 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
189 |
113 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
478 |
391 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
47 |
26 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
111 |
93 |
$4K |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$672.00 |
| D1999 |
|
452 |
402 |
$0.00 |