| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,483 |
1,446 |
$40K |
| D1110 |
Prophylaxis - adult |
580 |
571 |
$30K |
| D1120 |
Prophylaxis - child |
808 |
790 |
$28K |
| D0274 |
Bitewings - four radiographic images |
829 |
814 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,634 |
1,594 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
210 |
107 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,552 |
1,511 |
$18K |
| D0145 |
Oral evaluation for a patient under three years of age |
127 |
124 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,539 |
1,473 |
$17K |
| D1351 |
Sealant - per tooth |
601 |
113 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
201 |
105 |
$15K |
| D0272 |
Bitewings - two radiographic images |
289 |
282 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$423.84 |
| D0603 |
|
79 |
77 |
$0.00 |
| D0601 |
|
869 |
855 |
$0.00 |
| D0602 |
|
754 |
736 |
$0.00 |