| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
587 |
582 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
580 |
574 |
$15K |
| D0330 |
Panoramic radiographic image |
285 |
277 |
$15K |
| D1110 |
Prophylaxis - adult |
325 |
319 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
673 |
665 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
217 |
214 |
$10K |
| D0272 |
Bitewings - two radiographic images |
476 |
469 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
48 |
18 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$176.28 |