| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,699 |
1,465 |
$58K |
| D1110 |
Prophylaxis - adult |
1,436 |
1,249 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
2,577 |
2,227 |
$56K |
| D0274 |
Bitewings - four radiographic images |
814 |
708 |
$25K |
| D0330 |
Panoramic radiographic image |
272 |
235 |
$12K |
| D1206 |
Topical application of fluoride varnish |
633 |
527 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
97 |
70 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
383 |
329 |
$10K |
| D0272 |
Bitewings - two radiographic images |
176 |
160 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
12 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
69 |
56 |
$1K |