| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,205 |
2,156 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
2,287 |
2,246 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,753 |
1,728 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,436 |
2,396 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
2,564 |
2,536 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
311 |
311 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
375 |
370 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
281 |
277 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
57 |
26 |
$3K |
| D1120 |
Prophylaxis - child |
80 |
80 |
$2K |
| D1206 |
Topical application of fluoride varnish |
82 |
79 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$145.70 |
| D1999 |
|
15 |
14 |
$0.00 |