| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
603 |
583 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
395 |
387 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
650 |
627 |
$7K |
| D0330 |
Panoramic radiographic image |
242 |
230 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
311 |
303 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
87 |
69 |
$3K |
| D1206 |
Topical application of fluoride varnish |
1,100 |
1,045 |
$2K |
| D1120 |
Prophylaxis - child |
51 |
48 |
$1K |
| D0274 |
Bitewings - four radiographic images |
225 |
221 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23 |
17 |
$596.98 |
| D0140 |
Limited oral evaluation - problem focused |
42 |
42 |
$383.33 |
| D0220 |
Intraoral - periapical first radiographic image |
864 |
823 |
$329.40 |
| D1330 |
|
1,139 |
1,083 |
$237.61 |
| D0190 |
|
13 |
13 |
$165.44 |
| D0230 |
Intraoral - periapical each additional radiographic image |
418 |
376 |
$127.94 |
| D1310 |
|
505 |
501 |
$0.00 |
| D9986 |
|
211 |
210 |
$0.00 |