| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,159 |
2,122 |
$102K |
| D0120 |
Periodic oral evaluation - established patient |
3,721 |
3,666 |
$101K |
| D1120 |
Prophylaxis - child |
2,302 |
2,273 |
$79K |
| D0330 |
Panoramic radiographic image |
1,153 |
1,115 |
$54K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
604 |
331 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,607 |
2,574 |
$50K |
| D0272 |
Bitewings - two radiographic images |
1,807 |
1,767 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
322 |
304 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
865 |
843 |
$13K |
| D1206 |
Topical application of fluoride varnish |
327 |
323 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
113 |
52 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
569 |
544 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
57 |
56 |
$3K |
| D7111 |
|
21 |
14 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$581.88 |