| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,123 |
1,109 |
$56K |
| D0330 |
Panoramic radiographic image |
860 |
848 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
1,593 |
1,567 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
761 |
739 |
$26K |
| D1120 |
Prophylaxis - child |
695 |
691 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,610 |
1,590 |
$23K |
| D0274 |
Bitewings - four radiographic images |
493 |
490 |
$16K |
| D0272 |
Bitewings - two radiographic images |
236 |
236 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
47 |
15 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
12 |
$2K |
| D0602 |
|
2,020 |
1,977 |
$1K |
| D0603 |
|
690 |
676 |
$972.00 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$326.78 |