| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
643 |
625 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
834 |
825 |
$22K |
| D0330 |
Panoramic radiographic image |
180 |
175 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
506 |
499 |
$10K |
| D1120 |
Prophylaxis - child |
228 |
222 |
$7K |
| D0272 |
Bitewings - two radiographic images |
392 |
380 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
47 |
27 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
76 |
75 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
48 |
46 |
$603.20 |
| D0230 |
Intraoral - periapical each additional radiographic image |
45 |
42 |
$471.96 |