| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,435 |
2,320 |
$100K |
| D1120 |
Prophylaxis - child |
1,726 |
1,614 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
3,161 |
3,007 |
$58K |
| D0330 |
Panoramic radiographic image |
1,119 |
1,043 |
$42K |
| D0272 |
Bitewings - two radiographic images |
2,465 |
2,315 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
951 |
877 |
$24K |
| D1206 |
Topical application of fluoride varnish |
1,380 |
1,312 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
330 |
195 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
376 |
179 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
370 |
330 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
118 |
111 |
$985.24 |
| D9110 |
|
12 |
12 |
$254.31 |