| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,685 |
1,568 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
2,033 |
1,982 |
$56K |
| D0330 |
Panoramic radiographic image |
949 |
857 |
$48K |
| D1120 |
Prophylaxis - child |
1,128 |
1,125 |
$38K |
| D0272 |
Bitewings - two radiographic images |
2,350 |
2,302 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
747 |
591 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,437 |
1,433 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
159 |
56 |
$14K |
| D0274 |
Bitewings - four radiographic images |
136 |
100 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$165.00 |