| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
976 |
928 |
$41K |
| D0330 |
Panoramic radiographic image |
782 |
750 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
875 |
801 |
$27K |
| D0274 |
Bitewings - four radiographic images |
886 |
855 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
991 |
937 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
205 |
127 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
637 |
605 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
346 |
333 |
$9K |
| D1120 |
Prophylaxis - child |
212 |
195 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
891 |
798 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
123 |
64 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
121 |
65 |
$5K |
| D1206 |
Topical application of fluoride varnish |
25 |
25 |
$319.50 |
| D0230 |
Intraoral - periapical each additional radiographic image |
46 |
27 |
$274.68 |
| D9986 |
|
670 |
528 |
$0.00 |
| D1999 |
|
308 |
219 |
$0.00 |