| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
670 |
635 |
$16K |
| D1110 |
Prophylaxis - adult |
339 |
317 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
939 |
915 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,241 |
578 |
$11K |
| D0274 |
Bitewings - four radiographic images |
453 |
423 |
$10K |
| D1120 |
Prophylaxis - child |
324 |
312 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
804 |
762 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
134 |
129 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
62 |
38 |
$5K |
| D1351 |
Sealant - per tooth |
205 |
39 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
151 |
145 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
47 |
30 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
15 |
15 |
$2K |
| D0330 |
Panoramic radiographic image |
62 |
55 |
$1K |
| D0272 |
Bitewings - two radiographic images |
30 |
30 |
$603.20 |
| D0601 |
|
539 |
521 |
$0.03 |
| D0603 |
|
113 |
109 |
$0.00 |
| D0602 |
|
61 |
59 |
$0.00 |
| D1330 |
|
25 |
25 |
$0.00 |