| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,612 |
2,403 |
$103K |
| D0140 |
Limited oral evaluation - problem focused |
2,235 |
2,022 |
$67K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,196 |
610 |
$61K |
| D0274 |
Bitewings - four radiographic images |
2,157 |
2,030 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,937 |
1,797 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
1,969 |
1,817 |
$36K |
| D1120 |
Prophylaxis - child |
699 |
661 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
488 |
230 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,187 |
1,910 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
247 |
150 |
$9K |
| D0330 |
Panoramic radiographic image |
67 |
67 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
40 |
40 |
$614.40 |
| D0230 |
Intraoral - periapical each additional radiographic image |
108 |
83 |
$508.92 |
| D1999 |
|
79 |
64 |
$0.00 |