| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
283 |
268 |
$7K |
| D1120 |
Prophylaxis - child |
170 |
161 |
$6K |
| D0274 |
Bitewings - four radiographic images |
148 |
139 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
309 |
293 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
313 |
296 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
307 |
291 |
$3K |
| D1110 |
Prophylaxis - adult |
66 |
59 |
$3K |
| D1351 |
Sealant - per tooth |
87 |
19 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
29 |
15 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
70 |
69 |
$2K |
| D9986 |
|
80 |
79 |
$0.00 |
| D0603 |
|
357 |
342 |
$0.00 |