| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,096 |
1,029 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
1,020 |
985 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
113 |
66 |
$14K |
| D0274 |
Bitewings - four radiographic images |
394 |
369 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
321 |
308 |
$10K |
| D0330 |
Panoramic radiographic image |
53 |
50 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
25 |
$2K |
| D1206 |
Topical application of fluoride varnish |
79 |
76 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
33 |
29 |
$915.78 |
| D1120 |
Prophylaxis - child |
18 |
14 |
$317.52 |
| D1208 |
Topical application of fluoride, excluding varnish |
26 |
20 |
$260.28 |
| D0220 |
Intraoral - periapical first radiographic image |
17 |
15 |
$221.65 |
| D1999 |
|
33 |
29 |
$8.50 |