| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,520 |
1,494 |
$42K |
| D1110 |
Prophylaxis - adult |
649 |
635 |
$34K |
| D1120 |
Prophylaxis - child |
931 |
919 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,607 |
1,594 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,725 |
1,695 |
$20K |
| D0274 |
Bitewings - four radiographic images |
637 |
625 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,784 |
1,656 |
$18K |
| D0272 |
Bitewings - two radiographic images |
797 |
792 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
184 |
82 |
$17K |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
14 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
14 |
$2K |
| D0601 |
|
1,379 |
1,365 |
$0.00 |
| D0603 |
|
174 |
173 |
$0.00 |
| D0602 |
|
25 |
25 |
$0.00 |