| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
786 |
779 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
229 |
53 |
$20K |
| D1120 |
Prophylaxis - child |
507 |
502 |
$18K |
| D1110 |
Prophylaxis - adult |
283 |
279 |
$15K |
| D0274 |
Bitewings - four radiographic images |
437 |
433 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
97 |
97 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
820 |
811 |
$12K |
| D1351 |
Sealant - per tooth |
349 |
60 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
366 |
125 |
$4K |
| D0272 |
Bitewings - two radiographic images |
184 |
184 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
167 |
162 |
$2K |
| D9248 |
|
14 |
13 |
$2K |
| D0350 |
|
65 |
65 |
$1K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$452.12 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$428.20 |
| D0603 |
|
674 |
673 |
$0.00 |
| D0601 |
|
290 |
286 |
$0.00 |