| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,224 |
2,139 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,549 |
2,443 |
$64K |
| D0330 |
Panoramic radiographic image |
1,392 |
1,329 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,458 |
2,371 |
$35K |
| D0272 |
Bitewings - two radiographic images |
1,944 |
1,864 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
553 |
365 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
291 |
208 |
$17K |
| D1120 |
Prophylaxis - child |
319 |
311 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
358 |
358 |
$9K |