| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,794 |
1,742 |
$70K |
| D1120 |
Prophylaxis - child |
1,170 |
1,144 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
1,765 |
1,733 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,151 |
1,121 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,154 |
1,116 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,686 |
1,657 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
625 |
590 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
243 |
149 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
118 |
69 |
$6K |
| D0330 |
Panoramic radiographic image |
55 |
51 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
208 |
195 |
$2K |
| D0272 |
Bitewings - two radiographic images |
43 |
43 |
$698.18 |
| D1999 |
|
94 |
84 |
$0.00 |
| D9986 |
|
517 |
442 |
$0.00 |