| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
1,565 |
519 |
$12K |
| D1110 |
Prophylaxis - adult |
208 |
201 |
$10K |
| D1120 |
Prophylaxis - child |
261 |
258 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
275 |
265 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
486 |
477 |
$7K |
| D0274 |
Bitewings - four radiographic images |
217 |
207 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
592 |
562 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
194 |
190 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
34 |
22 |
$3K |
| D1351 |
Sealant - per tooth |
120 |
28 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
14 |
$2K |
| D0272 |
Bitewings - two radiographic images |
56 |
55 |
$1K |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$457.34 |
| D0602 |
|
57 |
56 |
$0.00 |
| D0603 |
|
418 |
412 |
$0.00 |