| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,238 |
1,207 |
$41K |
| D1110 |
Prophylaxis - adult |
568 |
541 |
$29K |
| D1206 |
Topical application of fluoride varnish |
687 |
679 |
$24K |
| D1120 |
Prophylaxis - child |
407 |
401 |
$15K |
| D0274 |
Bitewings - four radiographic images |
204 |
197 |
$7K |
| D0330 |
Panoramic radiographic image |
47 |
44 |
$2K |
| D0272 |
Bitewings - two radiographic images |
60 |
58 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
41 |
38 |
$1K |