| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,833 |
2,767 |
$132K |
| D0120 |
Periodic oral evaluation - established patient |
3,968 |
3,887 |
$105K |
| D0330 |
Panoramic radiographic image |
1,372 |
1,340 |
$78K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,338 |
3,280 |
$65K |
| D1120 |
Prophylaxis - child |
1,498 |
1,472 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
282 |
198 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,142 |
1,130 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
305 |
188 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
340 |
326 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
120 |
97 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
25 |
12 |
$2K |