| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
1,325 |
1,243 |
$44K |
| D1110 |
Prophylaxis - adult |
879 |
813 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
1,410 |
1,343 |
$35K |
| D1206 |
Topical application of fluoride varnish |
1,583 |
1,478 |
$31K |
| D1120 |
Prophylaxis - child |
382 |
365 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
104 |
50 |
$13K |
| D0603 |
|
535 |
515 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
72 |
24 |
$5K |
| D0330 |
Panoramic radiographic image |
26 |
24 |
$1K |
| D0602 |
|
39 |
39 |
$503.93 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$330.59 |
| D1330 |
|
14 |
13 |
$102.00 |