| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,504 |
1,404 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
904 |
866 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
602 |
549 |
$14K |
| D0330 |
Panoramic radiographic image |
346 |
305 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
236 |
153 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
200 |
153 |
$9K |
| D0274 |
Bitewings - four radiographic images |
367 |
332 |
$8K |
| D0272 |
Bitewings - two radiographic images |
453 |
430 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
204 |
188 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
434 |
405 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
198 |
181 |
$3K |
| D1120 |
Prophylaxis - child |
13 |
12 |
$519.48 |
| D0230 |
Intraoral - periapical each additional radiographic image |
18 |
12 |
$117.00 |
| D9986 |
|
61 |
42 |
$0.00 |