| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,089 |
2,043 |
$106K |
| D0330 |
Panoramic radiographic image |
943 |
910 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
1,689 |
1,655 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
469 |
121 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
184 |
73 |
$15K |
| D9110 |
|
359 |
341 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
249 |
243 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
699 |
658 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
246 |
220 |
$3K |
| D1120 |
Prophylaxis - child |
43 |
42 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
56 |
55 |
$2K |
| D0272 |
Bitewings - two radiographic images |
53 |
52 |
$1K |