| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,784 |
1,664 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,933 |
1,801 |
$39K |
| D0330 |
Panoramic radiographic image |
652 |
628 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
954 |
916 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,204 |
1,091 |
$29K |
| D1110 |
Prophylaxis - adult |
398 |
372 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
77 |
43 |
$9K |
| D0272 |
Bitewings - two radiographic images |
371 |
352 |
$9K |
| D0274 |
Bitewings - four radiographic images |
217 |
209 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
38 |
36 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
41 |
41 |
$676.50 |
| D1206 |
Topical application of fluoride varnish |
29 |
29 |
$616.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
14 |
$330.00 |