| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,521 |
1,406 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,908 |
1,727 |
$28K |
| D1120 |
Prophylaxis - child |
1,140 |
1,045 |
$28K |
| D1110 |
Prophylaxis - adult |
480 |
448 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
198 |
191 |
$8K |
| D0330 |
Panoramic radiographic image |
64 |
63 |
$3K |
| D0272 |
Bitewings - two radiographic images |
142 |
138 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
13 |
$2K |
| D0274 |
Bitewings - four radiographic images |
27 |
27 |
$817.45 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$170.16 |