| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,329 |
1,273 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
1,898 |
1,819 |
$37K |
| D0274 |
Bitewings - four radiographic images |
632 |
601 |
$19K |
| D1120 |
Prophylaxis - child |
566 |
548 |
$12K |
| D1206 |
Topical application of fluoride varnish |
572 |
537 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
147 |
90 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
634 |
617 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
104 |
101 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
119 |
78 |
$3K |
| D0272 |
Bitewings - two radiographic images |
139 |
138 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
37 |
26 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
191 |
168 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
49 |
44 |
$1K |
| D1999 |
|
22 |
20 |
$0.00 |