| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,705 |
1,563 |
$69K |
| D1120 |
Prophylaxis - child |
1,486 |
1,351 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,503 |
2,238 |
$57K |
| D0330 |
Panoramic radiographic image |
690 |
632 |
$27K |
| D0274 |
Bitewings - four radiographic images |
869 |
818 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
630 |
598 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
492 |
466 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
91 |
70 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
54 |
41 |
$3K |
| D0272 |
Bitewings - two radiographic images |
86 |
65 |
$975.31 |
| D1999 |
|
77 |
62 |
$0.00 |