| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
258 |
234 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
482 |
454 |
$9K |
| D1120 |
Prophylaxis - child |
212 |
194 |
$5K |
| D0274 |
Bitewings - four radiographic images |
149 |
136 |
$5K |
| D1206 |
Topical application of fluoride varnish |
313 |
289 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
76 |
38 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
119 |
104 |
$3K |
| D0330 |
Panoramic radiographic image |
44 |
39 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
43 |
36 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
31 |
25 |
$1K |