| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,563 |
1,563 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
2,268 |
2,265 |
$58K |
| D1120 |
Prophylaxis - child |
535 |
535 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,154 |
1,154 |
$18K |
| D0330 |
Panoramic radiographic image |
412 |
412 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
360 |
360 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
642 |
642 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
271 |
258 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
23 |
13 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
51 |
51 |
$619.04 |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$77.26 |
| D1999 |
|
73 |
69 |
$0.00 |