| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,158 |
2,154 |
$28K |
| D1120 |
Prophylaxis - child |
1,229 |
1,223 |
$26K |
| D1110 |
Prophylaxis - adult |
1,135 |
1,125 |
$24K |
| D1206 |
Topical application of fluoride varnish |
2,363 |
2,352 |
$23K |
| D0274 |
Bitewings - four radiographic images |
719 |
717 |
$8K |
| D0330 |
Panoramic radiographic image |
291 |
290 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
195 |
98 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
204 |
201 |
$4K |
| D0272 |
Bitewings - two radiographic images |
283 |
280 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$0.00 |