| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,664 |
1,640 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
496 |
200 |
$43K |
| D1110 |
Prophylaxis - adult |
859 |
848 |
$43K |
| D0272 |
Bitewings - two radiographic images |
1,292 |
1,277 |
$29K |
| D1120 |
Prophylaxis - child |
868 |
853 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,839 |
1,814 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,039 |
1,707 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,831 |
1,799 |
$22K |
| D0145 |
Oral evaluation for a patient under three years of age |
169 |
165 |
$19K |
| D1351 |
Sealant - per tooth |
390 |
95 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
203 |
193 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
85 |
83 |
$5K |
| D0274 |
Bitewings - four radiographic images |
193 |
190 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
44 |
21 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
24 |
14 |
$2K |
| D0602 |
|
727 |
717 |
$0.00 |
| D0601 |
|
685 |
668 |
$0.00 |
| D0603 |
|
918 |
907 |
$0.00 |