| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,846 |
1,843 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
2,590 |
2,588 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,770 |
1,767 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
1,501 |
1,490 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,027 |
2,017 |
$19K |
| D1120 |
Prophylaxis - child |
305 |
305 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
474 |
471 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
72 |
53 |
$3K |
| D0274 |
Bitewings - four radiographic images |
128 |
128 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
49 |
49 |
$1K |
| D0330 |
Panoramic radiographic image |
19 |
19 |
$462.91 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$111.80 |
| D1999 |
|
350 |
346 |
$0.00 |