| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,529 |
2,490 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
2,859 |
2,832 |
$67K |
| D1206 |
Topical application of fluoride varnish |
2,699 |
2,664 |
$54K |
| D0274 |
Bitewings - four radiographic images |
2,008 |
1,986 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
616 |
293 |
$44K |
| D0330 |
Panoramic radiographic image |
756 |
743 |
$30K |
| D1120 |
Prophylaxis - child |
874 |
871 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
892 |
884 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
536 |
529 |
$15K |
| D1351 |
Sealant - per tooth |
292 |
74 |
$8K |
| D0272 |
Bitewings - two radiographic images |
336 |
335 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
49 |
27 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
23 |
14 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
75 |
51 |
$494.52 |
| D0140 |
Limited oral evaluation - problem focused |
16 |
15 |
$341.60 |
| D1999 |
|
56 |
53 |
$0.00 |