| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,637 |
2,561 |
$68K |
| D1120 |
Prophylaxis - child |
1,995 |
1,921 |
$53K |
| D1206 |
Topical application of fluoride varnish |
2,782 |
2,682 |
$45K |
| D1110 |
Prophylaxis - adult |
751 |
733 |
$29K |
| D0272 |
Bitewings - two radiographic images |
489 |
473 |
$9K |
| D0330 |
Panoramic radiographic image |
71 |
70 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
96 |
95 |
$4K |
| D0274 |
Bitewings - four radiographic images |
93 |
92 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
12 |
$1K |