| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,068 |
1,925 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
2,785 |
2,625 |
$67K |
| D0274 |
Bitewings - four radiographic images |
1,193 |
1,118 |
$32K |
| D1120 |
Prophylaxis - child |
858 |
792 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
524 |
455 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,243 |
1,149 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
978 |
883 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
131 |
82 |
$12K |
| D0330 |
Panoramic radiographic image |
267 |
236 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
338 |
301 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
841 |
368 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
42 |
25 |
$3K |
| D4355 |
|
38 |
38 |
$3K |
| D1206 |
Topical application of fluoride varnish |
123 |
122 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
13 |
$1K |
| D0272 |
Bitewings - two radiographic images |
53 |
49 |
$786.30 |
| D1999 |
|
205 |
197 |
$0.00 |