| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
1,596 |
1,380 |
$74K |
| D1110 |
Prophylaxis - adult |
958 |
828 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,567 |
1,389 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
970 |
799 |
$33K |
| D1120 |
Prophylaxis - child |
843 |
788 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
649 |
612 |
$13K |
| D0272 |
Bitewings - two radiographic images |
422 |
370 |
$7K |
| D1206 |
Topical application of fluoride varnish |
91 |
89 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
41 |
15 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$105.00 |