| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,461 |
1,420 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
2,192 |
2,153 |
$39K |
| D0330 |
Panoramic radiographic image |
841 |
815 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,608 |
2,550 |
$37K |
| D1110 |
Prophylaxis - adult |
976 |
961 |
$33K |
| D0274 |
Bitewings - four radiographic images |
959 |
939 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,233 |
1,202 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
175 |
88 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
154 |
81 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
381 |
364 |
$8K |
| D1351 |
Sealant - per tooth |
230 |
69 |
$6K |