| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
1,608 |
1,582 |
$101K |
| D1120 |
Prophylaxis - child |
2,297 |
2,254 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
2,842 |
2,807 |
$85K |
| D1110 |
Prophylaxis - adult |
1,350 |
1,331 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,341 |
2,316 |
$51K |
| D0272 |
Bitewings - two radiographic images |
1,854 |
1,823 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
817 |
789 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
309 |
187 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
279 |
171 |
$20K |
| D1206 |
Topical application of fluoride varnish |
120 |
120 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
145 |
138 |
$2K |