| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
1,048 |
884 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,765 |
840 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,258 |
991 |
$9K |
| D1120 |
Prophylaxis - child |
300 |
267 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
412 |
326 |
$8K |
| D1351 |
Sealant - per tooth |
342 |
50 |
$7K |
| D1110 |
Prophylaxis - adult |
142 |
114 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
49 |
27 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
154 |
120 |
$3K |
| D0274 |
Bitewings - four radiographic images |
195 |
154 |
$3K |
| D0272 |
Bitewings - two radiographic images |
131 |
115 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
14 |
$2K |
| D0603 |
|
876 |
823 |
$9.03 |
| D0602 |
|
89 |
85 |
$2.04 |