| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
653 |
556 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
985 |
859 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,048 |
901 |
$19K |
| D1110 |
Prophylaxis - adult |
196 |
170 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
117 |
115 |
$4K |
| D0330 |
Panoramic radiographic image |
52 |
47 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
31 |
12 |
$3K |
| D0274 |
Bitewings - four radiographic images |
68 |
63 |
$2K |