| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,427 |
1,393 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
1,649 |
1,607 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
467 |
272 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,525 |
1,497 |
$31K |
| D0272 |
Bitewings - two radiographic images |
814 |
805 |
$14K |
| D0330 |
Panoramic radiographic image |
30 |
28 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
12 |
$951.60 |
| D1120 |
Prophylaxis - child |
14 |
13 |
$443.69 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
12 |
$152.16 |