| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,313 |
1,286 |
$31K |
| D1110 |
Prophylaxis - adult |
665 |
649 |
$26K |
| D1120 |
Prophylaxis - child |
393 |
383 |
$17K |
| D0272 |
Bitewings - two radiographic images |
861 |
842 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
776 |
757 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
182 |
137 |
$10K |
| D0330 |
Panoramic radiographic image |
218 |
217 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$109.28 |