| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,830 |
1,819 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
2,575 |
2,560 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,203 |
2,186 |
$35K |
| D0272 |
Bitewings - two radiographic images |
1,598 |
1,583 |
$30K |
| D1120 |
Prophylaxis - child |
823 |
817 |
$28K |
| D0330 |
Panoramic radiographic image |
563 |
558 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
185 |
184 |
$7K |
| D1206 |
Topical application of fluoride varnish |
193 |
193 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
30 |
13 |
$2K |
| D0274 |
Bitewings - four radiographic images |
68 |
68 |
$2K |