| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
802 |
792 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
329 |
321 |
$9K |
| D0274 |
Bitewings - four radiographic images |
398 |
391 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
471 |
198 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
563 |
507 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
419 |
415 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
31 |
12 |
$3K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$912.47 |
| D0140 |
Limited oral evaluation - problem focused |
28 |
27 |
$806.99 |
| D0230 |
Intraoral - periapical each additional radiographic image |
75 |
67 |
$682.91 |
| D1208 |
Topical application of fluoride, excluding varnish |
50 |
50 |
$540.60 |
| D4341 |
|
42 |
13 |
$0.00 |