| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,203 |
1,079 |
$44K |
| D0330 |
Panoramic radiographic image |
814 |
722 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,581 |
1,444 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
401 |
351 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
412 |
353 |
$12K |
| D1120 |
Prophylaxis - child |
315 |
296 |
$7K |
| D0272 |
Bitewings - two radiographic images |
373 |
336 |
$6K |
| D1206 |
Topical application of fluoride varnish |
239 |
213 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
258 |
248 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
27 |
12 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
12 |
$1K |