| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,423 |
1,309 |
$36K |
| D1120 |
Prophylaxis - child |
956 |
906 |
$32K |
| D1351 |
Sealant - per tooth |
1,102 |
196 |
$24K |
| D1110 |
Prophylaxis - adult |
531 |
487 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,679 |
1,582 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,160 |
1,545 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,806 |
1,639 |
$16K |
| D0274 |
Bitewings - four radiographic images |
620 |
566 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
202 |
80 |
$14K |
| D0272 |
Bitewings - two radiographic images |
573 |
538 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
53 |
48 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
88 |
44 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
63 |
62 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
143 |
122 |
$4K |
| D0330 |
Panoramic radiographic image |
127 |
113 |
$2K |
| D0603 |
|
2,143 |
2,029 |
$90.23 |
| D1330 |
|
104 |
96 |
$61.75 |