| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
2,221 |
893 |
$22K |
| D1120 |
Prophylaxis - child |
661 |
627 |
$22K |
| D0145 |
Oral evaluation for a patient under three years of age |
136 |
127 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
489 |
455 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
970 |
918 |
$13K |
| D1351 |
Sealant - per tooth |
471 |
82 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,088 |
1,014 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
385 |
367 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
78 |
32 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
79 |
26 |
$6K |
| D0272 |
Bitewings - two radiographic images |
301 |
284 |
$6K |
| D1110 |
Prophylaxis - adult |
79 |
75 |
$4K |
| D0274 |
Bitewings - four radiographic images |
116 |
108 |
$3K |
| D0330 |
Panoramic radiographic image |
67 |
62 |
$1K |
| D0603 |
|
736 |
711 |
$0.01 |
| D0602 |
|
375 |
361 |
$0.00 |