| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,252 |
3,190 |
$91K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
927 |
467 |
$90K |
| D1120 |
Prophylaxis - child |
2,524 |
2,482 |
$89K |
| D1351 |
Sealant - per tooth |
2,174 |
510 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,748 |
3,678 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
3,957 |
3,874 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,054 |
3,744 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,302 |
1,267 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
486 |
273 |
$37K |
| D1110 |
Prophylaxis - adult |
690 |
665 |
$36K |
| D0145 |
Oral evaluation for a patient under three years of age |
231 |
230 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,015 |
1,001 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
189 |
184 |
$6K |
| D0603 |
|
3,262 |
3,201 |
$0.02 |
| D0602 |
|
896 |
880 |
$0.00 |