| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
797 |
768 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,189 |
1,151 |
$28K |
| D1120 |
Prophylaxis - child |
529 |
520 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
494 |
470 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
667 |
653 |
$15K |
| D0274 |
Bitewings - four radiographic images |
439 |
424 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
117 |
105 |
$9K |
| D0330 |
Panoramic radiographic image |
112 |
105 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
163 |
160 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
512 |
481 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
32 |
26 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
26 |
16 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
176 |
147 |
$1K |
| D0272 |
Bitewings - two radiographic images |
28 |
28 |
$415.10 |
| D1330 |
|
20 |
20 |
$0.00 |