| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,960 |
1,919 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
1,878 |
1,845 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,634 |
1,600 |
$30K |
| D0330 |
Panoramic radiographic image |
200 |
191 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
185 |
181 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
238 |
230 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
79 |
24 |
$3K |
| D1120 |
Prophylaxis - child |
170 |
166 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
467 |
424 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19 |
12 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
40 |
39 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
111 |
109 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22 |
13 |
$147.45 |
| D0272 |
Bitewings - two radiographic images |
17 |
15 |
$140.00 |
| D1330 |
|
12 |
12 |
$0.00 |
| D1999 |
|
69 |
67 |
$0.00 |