| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,271 |
1,247 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
1,545 |
1,495 |
$35K |
| D1206 |
Topical application of fluoride varnish |
1,200 |
1,153 |
$19K |
| D1120 |
Prophylaxis - child |
325 |
317 |
$10K |
| D0272 |
Bitewings - two radiographic images |
170 |
168 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
39 |
25 |
$3K |
| D0330 |
Panoramic radiographic image |
56 |
54 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
69 |
64 |
$3K |
| D0274 |
Bitewings - four radiographic images |
53 |
46 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
12 |
$160.71 |
| D1999 |
|
65 |
60 |
$0.00 |