| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
619 |
549 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
799 |
710 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
224 |
196 |
$8K |
| D1206 |
Topical application of fluoride varnish |
441 |
388 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
42 |
26 |
$3K |
| D1120 |
Prophylaxis - child |
99 |
83 |
$2K |
| D0274 |
Bitewings - four radiographic images |
65 |
43 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
29 |
26 |
$2K |
| D0330 |
Panoramic radiographic image |
24 |
15 |
$1K |
| D1999 |
|
40 |
34 |
$0.00 |