| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,233 |
5,233 |
$178K |
| D0120 |
Periodic oral evaluation - established patient |
6,374 |
6,374 |
$127K |
| D0274 |
Bitewings - four radiographic images |
4,238 |
4,238 |
$80K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
887 |
728 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,153 |
911 |
$78K |
| D0220 |
Intraoral - periapical first radiographic image |
5,502 |
5,423 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,600 |
4,588 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
1,091 |
1,086 |
$17K |
| D0330 |
Panoramic radiographic image |
624 |
623 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,002 |
1,002 |
$11K |
| D1120 |
Prophylaxis - child |
204 |
204 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
98 |
88 |
$5K |
| D9110 |
|
26 |
26 |
$360.22 |
| D1999 |
|
26 |
25 |
$0.00 |