| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,178 |
1,154 |
$26K |
| D1120 |
Prophylaxis - child |
781 |
770 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
257 |
114 |
$19K |
| D0145 |
Oral evaluation for a patient under three years of age |
138 |
136 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,240 |
1,215 |
$14K |
| D1110 |
Prophylaxis - adult |
264 |
255 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
190 |
182 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
996 |
972 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
927 |
872 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
123 |
63 |
$7K |
| D0272 |
Bitewings - two radiographic images |
393 |
386 |
$7K |
| D1351 |
Sealant - per tooth |
199 |
53 |
$4K |
| D0274 |
Bitewings - four radiographic images |
143 |
139 |
$3K |
| D0603 |
|
1,137 |
1,114 |
$0.00 |
| D0602 |
|
77 |
76 |
$0.00 |
| D0601 |
|
228 |
222 |
$0.00 |