| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,183 |
1,121 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,753 |
1,355 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,521 |
1,441 |
$18K |
| D0274 |
Bitewings - four radiographic images |
500 |
469 |
$15K |
| D1120 |
Prophylaxis - child |
448 |
430 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,046 |
1,008 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
134 |
65 |
$12K |
| D1110 |
Prophylaxis - adult |
148 |
141 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
67 |
39 |
$5K |
| D1351 |
Sealant - per tooth |
117 |
26 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
15 |
12 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
34 |
33 |
$1K |
| D0272 |
Bitewings - two radiographic images |
26 |
24 |
$533.06 |
| D0603 |
|
1,699 |
1,637 |
$0.00 |
| D0602 |
|
53 |
52 |
$0.00 |