| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,047 |
1,009 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
504 |
485 |
$14K |
| D0330 |
Panoramic radiographic image |
140 |
133 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
575 |
550 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
275 |
165 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
83 |
82 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
86 |
60 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
206 |
199 |
$3K |
| D0274 |
Bitewings - four radiographic images |
939 |
904 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,111 |
1,069 |
$370.29 |
| D0220 |
Intraoral - periapical first radiographic image |
261 |
257 |
$60.98 |
| D1330 |
|
1,120 |
1,075 |
$32.89 |
| D0230 |
Intraoral - periapical each additional radiographic image |
69 |
68 |
$0.00 |