| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,178 |
1,133 |
$46K |
| D0274 |
Bitewings - four radiographic images |
487 |
469 |
$12K |
| D1120 |
Prophylaxis - child |
353 |
336 |
$11K |
| D1206 |
Topical application of fluoride varnish |
578 |
555 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
470 |
455 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
156 |
148 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
200 |
196 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
61 |
57 |
$3K |
| D0330 |
Panoramic radiographic image |
67 |
65 |
$2K |
| D0272 |
Bitewings - two radiographic images |
87 |
85 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$244.00 |