| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
681 |
668 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
795 |
783 |
$20K |
| D1206 |
Topical application of fluoride varnish |
784 |
773 |
$17K |
| D0330 |
Panoramic radiographic image |
357 |
348 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
105 |
70 |
$7K |
| D0274 |
Bitewings - four radiographic images |
231 |
229 |
$6K |
| D1120 |
Prophylaxis - child |
154 |
153 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
227 |
212 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
93 |
92 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
50 |
38 |
$3K |