| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
913 |
806 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,061 |
939 |
$21K |
| D1110 |
Prophylaxis - adult |
447 |
396 |
$21K |
| D1120 |
Prophylaxis - child |
583 |
527 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,071 |
957 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
853 |
755 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
861 |
750 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
51 |
44 |
$6K |
| D1351 |
Sealant - per tooth |
251 |
37 |
$5K |
| D0330 |
Panoramic radiographic image |
83 |
76 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
35 |
12 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
99 |
92 |
$3K |
| D0601 |
|
1,140 |
1,096 |
$0.00 |
| D0602 |
|
58 |
53 |
$0.00 |