| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,482 |
1,358 |
$46K |
| D0330 |
Panoramic radiographic image |
648 |
591 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
1,588 |
1,475 |
$24K |
| D0274 |
Bitewings - four radiographic images |
648 |
586 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
530 |
466 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
866 |
813 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
425 |
388 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
582 |
442 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
117 |
55 |
$6K |
| D1351 |
Sealant - per tooth |
528 |
53 |
$5K |
| D1120 |
Prophylaxis - child |
349 |
321 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
39 |
27 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
465 |
368 |
$2K |
| D0272 |
Bitewings - two radiographic images |
85 |
82 |
$684.75 |
| D1999 |
|
99 |
78 |
$0.00 |