| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
509 |
498 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
752 |
743 |
$16K |
| D1120 |
Prophylaxis - child |
278 |
276 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
369 |
365 |
$7K |
| D0330 |
Panoramic radiographic image |
168 |
164 |
$6K |
| D0272 |
Bitewings - two radiographic images |
391 |
381 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
213 |
210 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
62 |
46 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
163 |
160 |
$1K |
| D9110 |
|
14 |
13 |
$426.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$87.50 |