| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
1,277 |
1,227 |
$34K |
| D1120 |
Prophylaxis - child |
875 |
845 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
283 |
222 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
229 |
157 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
872 |
825 |
$24K |
| D1110 |
Prophylaxis - adult |
388 |
361 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
416 |
404 |
$14K |
| D0330 |
Panoramic radiographic image |
266 |
256 |
$11K |
| D0272 |
Bitewings - two radiographic images |
324 |
308 |
$9K |
| D0274 |
Bitewings - four radiographic images |
224 |
209 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
65 |
63 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
32 |
29 |
$853.00 |
| D9986 |
|
42 |
40 |
$0.00 |