| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,737 |
2,333 |
$70K |
| D0274 |
Bitewings - four radiographic images |
2,296 |
1,970 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,152 |
991 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,693 |
1,487 |
$29K |
| D0330 |
Panoramic radiographic image |
1,803 |
1,435 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
354 |
201 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
455 |
227 |
$21K |
| D1120 |
Prophylaxis - child |
534 |
494 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
740 |
623 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
52 |
39 |
$4K |
| D2160 |
|
58 |
25 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
89 |
75 |
$2K |
| D1206 |
Topical application of fluoride varnish |
43 |
42 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
12 |
$227.36 |
| D1999 |
|
40 |
37 |
$0.00 |