| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,958 |
1,793 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
2,994 |
2,731 |
$55K |
| D1206 |
Topical application of fluoride varnish |
2,657 |
2,404 |
$40K |
| D1120 |
Prophylaxis - child |
1,299 |
1,184 |
$35K |
| D0330 |
Panoramic radiographic image |
385 |
351 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
263 |
142 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
275 |
244 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
113 |
64 |
$6K |
| D0272 |
Bitewings - two radiographic images |
247 |
217 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
319 |
267 |
$3K |
| D0274 |
Bitewings - four radiographic images |
104 |
93 |
$2K |
| D0277 |
|
85 |
79 |
$943.34 |