| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,363 |
1,344 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,774 |
1,747 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,167 |
1,149 |
$27K |
| D0330 |
Panoramic radiographic image |
698 |
686 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
670 |
656 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
163 |
108 |
$8K |
| D1120 |
Prophylaxis - child |
192 |
187 |
$7K |
| D1206 |
Topical application of fluoride varnish |
419 |
416 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
61 |
60 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
120 |
117 |
$775.19 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
13 |
$690.58 |
| D9110 |
|
26 |
26 |
$525.42 |
| D9986 |
|
13 |
13 |
$0.00 |