| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,303 |
2,195 |
$106K |
| D0120 |
Periodic oral evaluation - established patient |
3,330 |
3,165 |
$70K |
| D0330 |
Panoramic radiographic image |
919 |
881 |
$52K |
| D1206 |
Topical application of fluoride varnish |
2,090 |
1,999 |
$39K |
| D1120 |
Prophylaxis - child |
888 |
856 |
$24K |
| D0274 |
Bitewings - four radiographic images |
687 |
643 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
250 |
213 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
224 |
219 |
$5K |
| D1351 |
Sealant - per tooth |
156 |
14 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
59 |
50 |
$3K |
| D1999 |
|
24 |
24 |
$0.00 |