| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,535 |
1,509 |
$41K |
| D1110 |
Prophylaxis - adult |
757 |
742 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,043 |
1,023 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,645 |
1,628 |
$28K |
| D1120 |
Prophylaxis - child |
677 |
667 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,578 |
1,555 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,735 |
1,696 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
141 |
63 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
27 |
13 |
$2K |
| D1351 |
Sealant - per tooth |
59 |
14 |
$2K |
| D0272 |
Bitewings - two radiographic images |
42 |
41 |
$928.18 |
| D0603 |
|
1,615 |
1,592 |
$0.00 |
| D0601 |
|
39 |
38 |
$0.00 |