| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,838 |
2,671 |
$129K |
| D0120 |
Periodic oral evaluation - established patient |
2,988 |
2,806 |
$65K |
| D0274 |
Bitewings - four radiographic images |
1,584 |
1,479 |
$51K |
| D1206 |
Topical application of fluoride varnish |
861 |
781 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
214 |
144 |
$11K |
| D1120 |
Prophylaxis - child |
164 |
148 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
82 |
49 |
$4K |
| D0330 |
Panoramic radiographic image |
43 |
40 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
104 |
88 |
$2K |
| D1999 |
|
18 |
13 |
$26.00 |