| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,202 |
1,188 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
1,571 |
1,553 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,934 |
2,894 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,021 |
1,005 |
$34K |
| D1120 |
Prophylaxis - child |
771 |
759 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
370 |
359 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,218 |
1,408 |
$24K |
| D0274 |
Bitewings - four radiographic images |
656 |
651 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,774 |
1,750 |
$21K |
| D1351 |
Sealant - per tooth |
465 |
68 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
77 |
77 |
$10K |
| D0350 |
|
295 |
291 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
46 |
24 |
$5K |
| D0603 |
|
1,483 |
1,461 |
$2K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$217.28 |
| D0601 |
|
1,318 |
1,296 |
$198.00 |
| D0602 |
|
164 |
163 |
$0.00 |
| D1999 |
|
49 |
48 |
$0.00 |