| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,060 |
1,893 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
3,663 |
3,398 |
$63K |
| D1120 |
Prophylaxis - child |
1,817 |
1,705 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,194 |
2,971 |
$42K |
| D0272 |
Bitewings - two radiographic images |
1,051 |
973 |
$16K |
| D1999 |
|
884 |
792 |
$16K |
| D0274 |
Bitewings - four radiographic images |
726 |
665 |
$15K |
| D0330 |
Panoramic radiographic image |
278 |
266 |
$12K |
| D1206 |
Topical application of fluoride varnish |
293 |
271 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
12 |
$783.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
32 |
31 |
$747.00 |
| D0220 |
Intraoral - periapical first radiographic image |
27 |
25 |
$256.55 |